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European Radiology
Published in: European Radiology 7/2019

01-07-2019 | Coronary Heart Disease | Cardiac

Evaluation of fractional flow reserve in patients with stable angina: can CT compete with angiography?

Authors: Xin Liu, Yabin Wang, Heye Zhang, Youbing Yin, Kunlin Cao, Zhifan Gao, Huafeng Liu, William Kongto Hau, Lei Gao, Yundai Chen, Feng Cao, Wenhua Huang

Published in: European Radiology | Issue 7/2019

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Abstract

Background

We aimed to compare the performance of FFRCT and FFRQCA in assessing the functional significance of coronary artery stenosis in patients suffering from coronary artery disease with stable angina.

Method

A total of 101 stable coronary heart disease (CAD) patients with 181 lesions were recruited. FFRCT and FFRQCA were compared using invasive fractional flow reserve (FFR) as a reference standard. Comparisons between FFRCT and FFRQCA were conducted based on strategies of the geometric reconstruction, boundary conditions, and geometric characteristics. The performance of FFRCT and FFRQCA in detecting hemodynamic significance was also investigated.

Results

The performance of FFRCT and FFRQCA in discriminating hemodynamically significant lesions was compared. Good correlation and agreement with invasive FFR was found using FFRCT and FFRQCA (r = 0.809, p < 0.001 and r = 0.755, p < 0.001). A significant difference was observed in the complex coronary artery tree, in which relatively better prediction was observed using FFRCT than FFRQCA when analyzing the stenosis distributed in the middle segment of a stenotic branch (p = 0.036). Moreover, FFRCT was found to be better at predicting hemodynamically insignificant stenosis than FFRQCA (p = 0.007), while the performance of the two parameters was similar in discriminating functional significant lesions using an FFR threshold of ≤ 0.8 as a reference standard.

Conclusion

FFRCT and FFRQCA could both accurately rule out functional insignificant lesions in stable CAD patients. FFRCT was found to be better for the noninvasive screening of CAD patients with stable angina than FFRQCA.

Key Points

• FFR CT and FFR QCA were both in good correlation and agreement with invasive FFR measurements.
• FFR CT is superior in accuracy and consistency compared to FFR QCA in patients with stenoses distributed in left coronary artery.
• The noninvasive nature of FFR CT could provide potential benefit for stable CAD patients on disease management.
Appendix
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Metadata
Title
Evaluation of fractional flow reserve in patients with stable angina: can CT compete with angiography?
Authors
Xin Liu
Yabin Wang
Heye Zhang
Youbing Yin
Kunlin Cao
Zhifan Gao
Huafeng Liu
William Kongto Hau
Lei Gao
Yundai Chen
Feng Cao
Wenhua Huang
Publication date
01-07-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 7/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06023-z

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