Verification of Coronary Computed Tomography-Derived Fractional Flow Reserve Measurement Site for Detection of Significant Coronary Artery Disease

• Published in: Circulation Reports 2021/12/10, Vol.3(12), pp.716-723
• Main Authors: Kawasaki, Tomohiro, Okonogi, Taichi, Koga, Hisashi, Orita, Yoshiya, Umeji, Kyoko, Fukuoka, Ryota, Hirai, Keisuke, Haraguchi, Kazuki, Kajiyama, Kimihiro, Fukami, Yurie, Soejima, Toshiya, Abe, Kensho, Yamabe, Hiroshige
• Format: Article
• Language: English
• Subjects: Coronary artery disease; Coronary computed tomography angiography (CCTA); FFR derived from CCTA (FFRCT); Fractional flow reserve (FFR); Imaging; Original article
• ISSN: 2434-0790; 2434-0790
• DOI: 10.1253/circrep.CR-21-0093

Background:The optimal site for measuring computed tomography (CT)-derived fractional flow reserve (FFRCT) to detect significant coronary artery disease (CAD) remains unknown. We investigated how diagnostic performance changes with FFRCTmeasurement site.Methods and Results:The diagnostic performance of FFRCT, measured 1–2 cm distal to the stenosis vs. a far-distal site, in detecting significant CAD with invasive fractional flow reserve ≤0.8 was evaluated in 254 diseased vessels from 146 patients with stable or suspected CAD diagnosed by coronary CT angiography. Receiver operating characteristic curve analysis revealed a significantly larger area under the curve for FFRCTmeasured 1–2 cm distal to the stenosis than at a far-distal site (0.829 vs. 0.791, respectively; P=0.0305). The rate of reclassification of positive FFRCTwas 19% for measurements made 1–2 cm distal to the stenosis, and diagnostic accuracy for FFRCT0.71–0.80 improved from 36% to 58% (P=0.0052). Vessel-based diagnostic accuracy of FFRCT1–2 cm distal to the stenosis and at a far-distal site was 75% and 65%, respectively (P