Diagnostic performance of on-site computed CT-fractional flow reserve based on fluid structure interactions: comparison with invasive fractional flow reserve and instantaneous wave-free ratio

• Published in: European heart journal cardiovascular imaging 2019-03, Vol.20 (3), p.343-352
• Main Authors: Fujimoto, Shinichiro, Kawasaki, Tomonori, Kumamaru, Kanako K, Kawaguchi, Yuko, Dohi, Tomotaka, Okonogi, Taichi, Ri, Keiken, Yamada, Sou, Takamura, Kazuhisa, Kato, Etsuro, Kato, Yoshiteru, Hiki, Makoto, Okazaki, Shinya, Aoki, Shigeki, Mitsouras, Dimitris, Rybicki, Frank J, Daida, Hiroyuki
• Format: Article
• Language: English
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jey104

Abstract Aims We evaluated diagnostic accuracy of CT-fractional flow reserve (CT-FFR) computed on-site with a new vendor workstation, against invasive FFR as the reference standard. Methods and results Retrospective analyses compared CT-FFR of 104 vessels with 30–90% diameter stenosis in 75 patients imaged using single-rotation 320 detector-row coronary CT angiography (CCTA) with invasive FFR performed within 90 days. Prospective ECG-gated CCTA included exposure of 70–99% of the R-R interval. CT-FFR was computed on-site within the same physical space as the CT scanner and reading room. The diagnostic accuracy of CCTA >50% and CT-FFR ≤0.8 to detect hemodynamically significant stenosis, defined as FFR ≤0.8, was determined, as was the correlation of CT-FFR to FFR and instantaneous wave-free ratio (iFR). Forty-four vessels (42.3%) had an invasive FFR ≤0.8. The sensitivity, specificity, positive, and negative predictive value of CT-FFR ≤0.8 vs. CCTA >50% to detect hemodynamically significant stenosis defined as FFR ≤0.8 were 90.9% vs. 70.5%, 78.3% vs. 43.3%, 75.5% vs. 47.7%, and 92.2% vs. 66.7%, respectively. Area under the curve of CT-FFR was significantly higher than CCTA >50% [0.85, 95% confidence interval (CI): 0.76–0.91 vs. 0.57, 95% CI: 0.47–0.67; P