title: Combined diagnostic performance of coronary computed tomography angiography and computed tomography derived fractional flow reserve for the evaluation of myocardial ischemia: A meta-analysis.
abstract: BACKGROUND
  To evaluate the combined diagnostic accuracy of coronary computed tomography angiography (CCTA) and computed tomography derived fractional flow reserve (FFRct) in patients with suspected or known coronary artery disease (CAD).
  
  
  METHODS
  PubMed, The Cochrane library, Embase and OpenGray were searched to identify studies comparing diagnostic accuracy of CCTA and FFRct. Diagnostic test measurements of FFRct were either extracted directly from the published papers or calculated from provided information. Bivariate models were conducted to synthesize the diagnostic performance of combined CCTA and FFRct at both "per-vessel" and "per-patient" levels.
  
  
  RESULTS
  7 articles were included for analysis. The combined diagnostic outcomes from "both positive" strategy, i.e. a subject was considered as "positive" only when both CCTA and FFRct were "positive", demonstrated relative high specificity (per-vessel: 0.91; per-patient: 0.81), high positive likelihood ratio (LR+, per-vessel: 7.93; per-patient: 4.26), high negative likelihood ratio (LR-, per-vessel: 0.30; per patient: 0.24) and high accuracy (per-vessel: 0.91; per-patient: 0.81) while "either positive" strategy, i.e. a subject was considered as "positive" when either CCTA or FFRct was "positive", demonstrated relative high sensitivity (per-vessel: 0.97; per-patient: 0.98), low LR+ (per-vessel: 1.50; per-patient: 1.17), low LR- (per-vessel: 0.07; per-patient: 0.09) and low accuracy (per-vessel: 0.57; per-patient: 0.54).
  
  
  CONCLUSIONS
  "Both positive" strategy showed better diagnostic performance to rule in patients with non-significant stenosis compared to "either positive" strategy, as it efficiently reduces the proportion of testing false positive subjects.
authors.affiliation: National Heart Center Singapore, Singapore.
authors.forename: Xiao Wei
authors.initials: XW
authors.lastname: Tan
authors.affiliation: Singapore Clinical Research Institute, Singapore.
authors.forename: Qishi
authors.initials: Q
authors.lastname: Zheng
authors.affiliation: Singapore Clinical Research Institute, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Luming
authors.initials: L
authors.lastname: Shi
authors.affiliation: National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Fei
authors.initials: F
authors.lastname: Gao
authors.affiliation: Duke-NUS Medical School, Singapore.
authors.forename: John Carson
authors.initials: JC
authors.lastname: Allen
authors.affiliation: Department of Radiology and Cardiology, Erasmus University Medical Center, Rotterdam, Netherland.
authors.forename: Adriaan
authors.initials: A
authors.lastname: Coenen
authors.affiliation: First Department of Medicine-Cardiology, University Medical Centre Mannheim, affiliated at the DZHK (German Centre for Cardiovascular Research), Mannheim, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Baumann
authors.affiliation: Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.affiliation: California Medical Innovation Institute, San Diego, CA, United States.
authors.forename: Ghassan S
authors.initials: GS
authors.lastname: Kassab
authors.affiliation: National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Soo Teik
authors.initials: ST
authors.lastname: Lim
authors.affiliation: National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Aaron Sung Lung
authors.initials: ASL
authors.lastname: Wong
authors.affiliation: National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Jack Wei Chieh
authors.initials: JWC
authors.lastname: Tan
authors.affiliation: National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Khung Keong
authors.initials: KK
authors.lastname: Yeo
authors.affiliation: National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Chee Tang
authors.initials: CT
authors.lastname: Chin
authors.affiliation: National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Kay Woon
authors.initials: KW
authors.lastname: Ho
authors.affiliation: National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Swee Yaw
authors.initials: SY
authors.lastname: Tan
authors.affiliation: National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Terrance Siang Jin
authors.initials: TSJ
authors.lastname: Chua
authors.affiliation: Singapore Clinical Research Institute, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Edwin Shih Yen
authors.initials: ESY
authors.lastname: Chan
authors.affiliation: National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Ru San
authors.initials: RS
authors.lastname: Tan
authors.affiliation: National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore. Electronic address: zhong.liang@nhcs.com.sg.
authors.forename: Liang
authors.initials: L
authors.lastname: Zhong
mesh_terms: D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D061827:Dimensional Measurement Accuracy; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D064847:Multimodal Imaging; D017202:Myocardial Ischemia / Q000175:diagnosis*
keywords: Computed tomography derived fractional flow reserve; Coronary artery disease; Coronary artery stenosis; Coronary computed tomography angiography