title: Feasibility and diagnostic performance of fractional flow reserve measurement derived from coronary computed tomography angiography in real clinical practice.
abstract: Non-invasive fractional flow reserve measured by coronary computed tomography angiography (FFRCT) has demonstrated a high diagnostic accuracy for detecting coronary artery disease (CAD) in selected patients in prior clinical trials. However, feasibility of FFRCTin unselected population have not been fully evaluated. Among 60 consecutive patients who had suspected significant CAD by coronary computed tomography angiography (CCTA) and were planned to undergo invasive coronary angiography, 48 patients were enrolled in this study comparing FFRCTwith invasive fractional flow reserve (FFR) without any exclusion criteria for the quality of CCTA image. FFRCTwas measured in a blinded fashion by an independent core laboratory. FFRCTvalue was evaluable in 43 out of 48 (89.6 %) patients with high prevalence of severe calcification in CCTA images [calcium score (CS) >400: 40 %, and CS > 1000: 19 %). Per-vessel FFRCTvalue showed good correlation with invasive FFR value (Spearman's rank correlation = 0.69, P < 0.001). The area under the receiver operator characteristics curve (AUC) of FFRCTwas 0.87. Per-vessel accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 68.6, 92.9, 52.4, 56.5, and 91.7 %, respectively. Even in eight patients (13 vessels) with extremely severely calcified lesions (CS > 1000), per-vessel FFRCTvalue showed a diagnostic performance similar to that in patients with CS ≤ 1000 (Spearman's rank correlation = 0.81, P < 0.001). FFRCTcould be measured in the majority of consecutive patients who had suspected significant CAD by CCTA in real clinical practice and demonstrated good diagnostic performance for detecting hemodynamically significant CAD even in patients with extremely severe calcified vessels.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Tetsuma
authors.initials: T
authors.lastname: Kawaji
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. hishiomi@kuhp.kyoto-u.ac.jp.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.affiliation: Morishita Heart Clinic, Kyoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morishita
authors.affiliation: Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: HeartFlow Inc., Redwood City, USA.|Department of Bioengineering, Stanford University, Stanford, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Taylor
authors.affiliation: Department of Radiology, Graduate School of Medicine, Kyoto University, Kyoto, USA.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Kanao
authors.affiliation: Department of Radiology, Graduate School of Medicine, Kyoto University, Kyoto, USA.
authors.forename: Koji
authors.initials: K
authors.lastname: Koizumi
authors.affiliation: Department of Radiology, Graduate School of Medicine, Kyoto University, Kyoto, USA.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kozawa
authors.affiliation: Morishita Heart Clinic, Kyoto, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Morihiro
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Tazaki
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Imai
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Naritatsu
authors.initials: N
authors.lastname: Saito
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shizuta
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Koh
authors.initials: K
authors.lastname: Ono
authors.affiliation: Department of Radiology, Graduate School of Medicine, Kyoto University, Kyoto, USA.
authors.forename: Kaori
authors.initials: K
authors.lastname: Togashi
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D019540:Area Under Curve; D006328:Cardiac Catheterization; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Coronary computed tomography angiography; Fractional flow reserve; Fractional flow reserve-computed tomography angiography