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European Radiology
Published in: European Radiology 2/2020

01-02-2020 | CT Angiography | Cardiac

Computed tomography angiography-derived fractional flow reserve (CT-FFR) for the detection of myocardial ischemia with invasive fractional flow reserve as reference: systematic review and meta-analysis

Authors: Baiyan Zhuang, Shuli Wang, Shihua Zhao, Minjie Lu

Published in: European Radiology | Issue 2/2020

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Abstract

Objectives

A method named computed tomography angiography-derived fractional flow reserve (FFRCT) is an alternative method for detecting hemodynamically significant coronary stenosis. We carried out a meta-analysis to derive reliable assessment of the diagnostic performances of FFRCT and compare the diagnostic accuracy with CCTA using FFR as reference.

Methods

We searched PubMed, EMBASE, The Cochrane Library, and Web of science for relevant articles published from January 2008 until May 2019 using the following search terms: FFRCT, noninvasive FFR, non-invasive FFR, noninvasive fractional flow reserve, non-invasive fractional flow reserve, and CCTA. Pooled estimates of sensitivity and specificity with the corresponding 95% confidence intervals (CIs) and the summary receiver operating characteristic curve (sROC) were determined.

Results

Sixteen studies published between 2011 and 2019 were included with a total of 1852 patients and 2731 vessels. The pooled sensitivity and specificity for FFRCT at the per-patient level was 89% (95% CI, 85–92%) and 71% (95% CI, 61–80%), respectively, while on the per-vessel basis was 85% (95% CI, 82–88%) and 82% (95% CI, 75–87%), respectively. No apparent difference in the sensitivity at per-patient and per-vessel level between FFRCT and CCTA was observed (0.89 versus 0.93 at per-patient; 0.85 versus 0.88 at per-vessel). However, the specificity of FFRCT was higher than CCTA (0.71 versus 0.32 at per-patient analysis; 0.82 versus 0.46 at per-vessel analysis).

Conclusions

FFRCT obtained a high diagnostic performance and is a viable alternative to FFR for detecting coronary ischemic lesions.

Key Points

• Noninvasive FFRCThas higher specificity for anatomical and physiological assessment of coronary artery stenosis compared with CCTA.
• Noninvasive FFRCTis a viable alternative to invasive FFR for the detection and exclusion of coronary lesions that cause ischemia.
Appendix
Available only for authorised users
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Metadata
Title
Computed tomography angiography-derived fractional flow reserve (CT-FFR) for the detection of myocardial ischemia with invasive fractional flow reserve as reference: systematic review and meta-analysis
Authors
Baiyan Zhuang
Shuli Wang
Shihua Zhao
Minjie Lu
Publication date
01-02-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 2/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06470-8

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