title: Comparison of Coronary Computed Tomography Angiography-Derived vs Invasive Fractional Flow Reserve Assessment: Meta-Analysis with Subgroup Evaluation of Intermediate Stenosis.
abstract: Invasive coronary angiography (ICA) with fractional flow reserve (FFR) assessment is the reference standard for the detection of hemodynamically relevant coronary lesions. We have investigated whether coronary computed tomography angiography (cCTA)-derived FFR (fractional flow reserve from coronary computed tomographic angiography [CT-FFR]) measurement improves diagnostic accuracy over cCTA.
  
  
  
  A literature search was performed for studies comparing invasive FFR, cCTA, and CT-FFR. The analysis included three prospective multicenter trials and two retrospective single-center studies; a total of 765 patients and 1306 vessels were included in the meta-analysis. Compared to invasive FFR on a per-lesion basis, CT-FFR reached a pooled sensitivity, specificity, positive predictive value, and negative predictive value of 83.7% (95% confidence interval [CI]: 78.1-89.3), 74.7% (95% CI: 52.2-97.1), 64.8% (95% CI: 52.1-77.5), and 90.1% (95% CI: 80.8-99.3) compared to 84.6% (95% CI: 78.1-91.1), 49.7% (95% CI: 31.1-68.4), 39.0% (95% CI: 28.0-50.1), and 87.3% (95% CI: 72.5-100.0) for cCTA alone. In 634 vessels with intermediate stenosis (30%-70%), sensitivity, specificity, positive predictive value, and negative predictive value were 81.4% (95% CI: 70.4-92.9), 71.7% (95% CI: 54.5-89.0), 59.4% (95% CI: 35.5-83.4), and 89.9% (95% CI: 85.0-94.7) compared to 90.2% (95% CI: 80.6-99.9), 35.4% (95% CI: 23.5-47.3), 50.7% (95% CI: 30.6-70.8), and 82.5% (95% CI: 64.5-100.0) for cCTA alone. The summary area under the receiver operating characteristic curve of CT-FFR was superior to cCTA alone on a per-vessel (0.90 [95% CI: 0.82-0.98] vs 0.74 [95% CI: 0.63-0.86]; P = .0047) and for intermediate stenoses (0.76 [95% CI: 0.65-0.88] vs 0.57 [95% CI: 0.49-0.66]; P = .0027).
  
  
  
  CT-FFR significantly improves specificity without noticeably altering the sensitivity of cCTA with invasive FFR as a reference standard for the detection of hemodynamically relevant stenosis.
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260, USA; 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Baumann
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260, USA; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Renker
authors.affiliation: Institute of Medical Statistics and Biometry, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Hetjens
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Fuller
authors.affiliation: 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Becher
authors.affiliation: 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Loßnitzer
authors.affiliation: 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Lehmann
authors.affiliation: 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
authors.affiliation: 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.affiliation: 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Lang
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Julian L
authors.initials: JL
authors.lastname: Wichmann
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260, USA. Electronic address: schoepf@musc.edu.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
mesh_terms: D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Coronary artery disease; coronary computed tomography angiography; fractional flow reserve; intermediate stenosis; meta-analysis