Feasibility and diagnostic performance of fractional flow reserve measurement derived from coronary computed tomography angiography in real clinical practice

• Published in: International Journal of Cardiovascular Imaging 2017-02, Vol.33 (2), p.271-281
• Main Authors: Kawaji, Tetsuma, Shiomi, Hiroki, Morishita, Hiroshi, Morimoto, Takeshi, Taylor, Charles A., Kanao, Shotaro, Koizumi, Koji, Kozawa, Satoshi, Morihiro, Kazuhisa, Watanabe, Hirotoshi, Tazaki, Junichi, Imai, Masao, Saito, Naritatsu, Shizuta, Satoshi, Ono, Koh, Togashi, Kaori, Kimura, Takeshi
• Format: Article
• Language: English
• Subjects: Aged; Area Under Curve; Cardiac Catheterization; Cardiac Imaging; Cardiology; Computed Tomography Angiography; Coronary Angiography - methods; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Cross-Sectional Studies; Feasibility Studies; Female; Fractional Flow Reserve, Myocardial; Humans; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Myocardial Perfusion Imaging - methods; Original Paper; Predictive Value of Tests; Prognosis; Prospective Studies; Radiographic Image Interpretation, Computer-Assisted; Radiology; Reproducibility of Results; ROC Curve; Severity of Illness Index; Vascular Calcification - diagnostic imaging; Vascular Calcification - physiopathology
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-016-0995-9

Non-invasive fractional flow reserve measured by coronary computed tomography angiography (FFR CT ) has demonstrated a high diagnostic accuracy for detecting coronary artery disease (CAD) in selected patients in prior clinical trials. However, feasibility of FFR CT in unselected population have not been fully evaluated. Among 60 consecutive patients who had suspected significant CAD by coronary computed tomography angiography (CCTA) and were planned to undergo invasive coronary angiography, 48 patients were enrolled in this study comparing FFR CT with invasive fractional flow reserve (FFR) without any exclusion criteria for the quality of CCTA image. FFR CT was measured in a blinded fashion by an independent core laboratory. FFR CT value was evaluable in 43 out of 48 (89.6 %) patients with high prevalence of severe calcification in CCTA images [calcium score (CS) >400: 40 %, and CS > 1000: 19 %). Per-vessel FFR CT value showed good correlation with invasive FFR value (Spearman’s rank correlation = 0.69, P  1000), per-vessel FFR CT value showed a diagnostic performance similar to that in patients with CS ≤ 1000 (Spearman’s rank correlation = 0.81, P