title: Comparison of diagnostic value of a novel noninvasive coronary computed tomography angiography method versus standard coronary angiography for assessing fractional flow reserve.
abstract: Noninvasive fractional flow reserve (FFR) from coronary computed tomography angiography (cCTA) correlates well with invasive FFR and substantially improves the detection of obstructive coronary artery disease. However, with current algorithms, computed tomography (CT)-based FFR is derived off-site in an involved time-consuming manner. We sought to investigate the diagnostic performance of a novel CT-based FFR algorithm, developed for time-efficient in-hospital evaluation of hemodynamically indeterminate coronary lesions. In a blinded fashion, CT-based FFR was assessed in 67 coronary lesions of 53 patients. Pressure guidewire-based FFR <0.80 served as the reference standard to define hemodynamically significant stenosis and assess the diagnostic performance of CT-based FFR compared with standard evaluation of cCTA (luminal diameter stenosis of ≥50%). We recorded the time needed for derivation of CT-based FFR. On a per-lesion and per-patient basis, CT-based FFR resulted in a sensitivity of 85% and 94%, a specificity of 85% and 84%, a positive predictive value of 71% and 71%, and a negative predictive value of 93% and 97%, respectively. The area under the receiver operating characteristic curve on a per-lesion basis was significantly greater for CT-based FFR compared with standard evaluation of cCTA (0.92 vs 0.72, p = 0.0049). A similar trend, albeit not statistically significant, was observed on per-patient analysis (0.91 vs 0.78, p = 0.078). Mean total time for CT-based FFR was 37.5 ± 13.8 minutes. In conclusion, the CT-based FFR algorithm evaluated here outperforms standard evaluation of cCTA for the detection of hemodynamically significant stenoses while allowing on-site application within clinically viable time frames.
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Charleston, South Carolina; Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Renker
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Charleston, South Carolina. Electronic address: schoepf@musc.edu.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Charleston, South Carolina; Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Charleston, South Carolina; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Meinel
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Rier
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Bayer
authors.affiliation: Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.affiliation: Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Charleston, South Carolina; First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Baumann
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies