ISSN 2996-8215
International Journal of Cardiology | Vol. 8, No. 5, May 2017 | pp. 33–40
DOI: 10.46882/2017/IJC/000098
Original Research Article
Diagnostic Performance of Fractional Flow Reserve derived from Computed Tomography in Intermediate Coronary Lesions
Kenji Takahashi¹, Satoshi Yamada¹, Kazuo Sato²
¹Department of Cardiovascular Imaging, Tokyo Heart Center, Tokyo, Japan
²Division of Cardiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Abstract:
Computed tomography coronary angiography (CTCA) is well established for ruling out significant coronary artery disease (CAD), but it lacks the physiological capacity to assess the hemodynamic significance of anatomical stenoses. Fractional flow reserve derived from standard CTCA datasets (FFR-CT) utilizes computational fluid dynamics to non-invasively estimate blood flow. This prospective clinical study evaluated the diagnostic performance of FFR-CT in identifying ischemia-producing lesions, using invasive FFR as the gold standard reference. We evaluated 115 symptomatic patients with intermediate coronary lesions (defined as 30% to 70% lumen diameter reduction on CTCA) who were scheduled for diagnostic invasive coronary angiography and fractional flow reserve. FFR-CT was computed off-line using specialized fluid dynamics simulation software, with ischemia defined as an FFR-CT less than or equal to 0.80. On a vessel-based analysis (142 vessels total), invasive FFR confirmed lesion-specific ischemia in 45 vessels (31.7%). The non-invasive FFR-CT demonstrated a diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 88.9% (95% CI: 75.9%–96.3%), 86.6% (95% CI: 78.2%–92.7%), 75.5% (95% CI: 61.7%–86.2%), and 94.4% (95% CI: 87.5%–98.2%), respectively. The area under the receiver operating characteristic curve (AUC) for FFR-CT was significantly higher than that of anatomical CTCA stenosis assessment alone (0.91 vs. 0.74, p < 0.001). FFR-CT provides excellent diagnostic accuracy and a high negative predictive value for identifying hemodynamically significant coronary stenoses.
Keywords: Fractional flow reserve, Computed tomography coronary angiography, Computational fluid dynamics, Myocardial ischemia, Diagnostic accuracy, Intermediate lesions
Received: February 14, 2012; Revised: March 28, 2012; Accepted: April 14, 2012; Published: May 22, 2017