title: Noninvasive fractional flow reserve derived from coronary computed tomography angiography for identification of ischemic lesions: a systematic review and meta-analysis.
abstract: Detection of coronary ischemic lesions by fractional flow reserve (FFR) has been established as the gold standard. In recent years, novel computer based methods have emerged and they can provide simulation of FFR using coronary artery images acquired from coronary computed tomography angiography (FFRCT). This meta-analysis aimed to evaluate diagnostic performance of FFRCT using FFR as the reference standard. Databases of PubMed, Cochrane Library, EMBASE, Medion and Web of Science were searched. Seven studies met the inclusion criteria, including 833 stable patients (1377 vessels or lesions) with suspected or known coronary artery disease (CAD). The patient-based analysis showed pooled estimates of sensitivity, specificity and diagnostic odds ratio (DOR) for detection of ischemic lesions were 0.89 [95%confidence interval (CI), 0.85-0.93], 0.76 (95%CI, 0.64-0.84) and 26.21 (95%CI, 13.14-52.28). At a per-vessel or per-lesion level, the pooled estimates were as follows: sensitivity 0.84 (95%CI, 0.80-0.87), specificity 0.76 (95%CI, 0.67-0.83) and DOR 16.87 (95%CI, 9.41-30.25). Area under summary receiver operating curves was 0.90 (95%CI, 0.87-0.92) and 0.86 (95%CI, 0.83-0.89) at the two analysis levels, respectively. In conclusion, FFRCT technology achieves a moderate diagnostic performance for noninvasive identification of ischemic lesions in stable patients with suspected or known CAD in comparison to invasive FFR measurement.
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R. China.
authors.forename: Wen
authors.initials: W
authors.lastname: Wu
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R. China.
authors.forename: Dao-Rong
authors.initials: DR
authors.lastname: Pan
authors.affiliation: National Heart Research Institute, National Heart Centre Singapore, 169609, Singapore.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Foin
authors.affiliation: Department of Cardiology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China.
authors.forename: Si
authors.initials: S
authors.lastname: Pang
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R. China.
authors.forename: Peng
authors.initials: P
authors.lastname: Ye
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, 8000, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Holm
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R. China.
authors.forename: Xiao-Min
authors.initials: XM
authors.lastname: Ren
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R. China.
authors.forename: Jie
authors.initials: J
authors.lastname: Luo
authors.affiliation: Division of Vascular Surgery, West Virginia University, Morgantown, 25304, USA.
authors.forename: Aravinda
authors.initials: A
authors.lastname: Nanjundappa
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R. China.
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
mesh_terms: D000368:Aged; D000072226:Computed Tomography Angiography / Q000379:methods* / Q000592:standards; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012680:Sensitivity and Specificity