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Published in: The International Journal of Cardiovascular Imaging 2/2017

01-02-2017 | Original Paper

Feasibility and diagnostic performance of fractional flow reserve measurement derived from coronary computed tomography angiography in real clinical practice

Authors: Tetsuma Kawaji, Hiroki Shiomi, Hiroshi Morishita, Takeshi Morimoto, Charles A. Taylor, Shotaro Kanao, Koji Koizumi, Satoshi Kozawa, Kazuhisa Morihiro, Hirotoshi Watanabe, Junichi Tazaki, Masao Imai, Naritatsu Saito, Satoshi Shizuta, Koh Ono, Kaori Togashi, Takeshi Kimura

Published in: The International Journal of Cardiovascular Imaging | Issue 2/2017

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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 FFRCT in 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 FFRCT with invasive fractional flow reserve (FFR) without any exclusion criteria for the quality of CCTA image. FFRCT was measured in a blinded fashion by an independent core laboratory. FFRCT value 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 FFRCT value 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 FFRCT was 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 FFRCT value showed a diagnostic performance similar to that in patients with CS ≤ 1000 (Spearman’s rank correlation = 0.81, P < 0.001). FFRCT could 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.
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Literature
1.
go back to reference Zorlak A, Zorlak A, Thomassen A et al (2015) Patients with suspected coronary artery disease referred for examinations in the era of coronary computed tomography angiography. Am J Cardiol 116:344–349CrossRefPubMed Zorlak A, Zorlak A, Thomassen A et al (2015) Patients with suspected coronary artery disease referred for examinations in the era of coronary computed tomography angiography. Am J Cardiol 116:344–349CrossRefPubMed
2.
go back to reference Miller JM, Rochitte CE, Dewey M et al (2008) Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 359:2324–2336CrossRefPubMed Miller JM, Rochitte CE, Dewey M et al (2008) Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 359:2324–2336CrossRefPubMed
3.
go back to reference Meijboom WB, Meijs MF, Schuijf JD et al (2008) Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 52:2135–2144CrossRefPubMed Meijboom WB, Meijs MF, Schuijf JD et al (2008) Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 52:2135–2144CrossRefPubMed
4.
go back to reference Puchner SB, Liu T, Mayrhofer T et al (2014) High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol 64:684–692CrossRefPubMedPubMedCentral Puchner SB, Liu T, Mayrhofer T et al (2014) High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol 64:684–692CrossRefPubMedPubMedCentral
5.
go back to reference Min JK, Shaw LJ, Berman DS (2010) The present state of coronary computed tomography angiography a process in evolution. J Am Coll Cardiol 55:957–965CrossRefPubMed Min JK, Shaw LJ, Berman DS (2010) The present state of coronary computed tomography angiography a process in evolution. J Am Coll Cardiol 55:957–965CrossRefPubMed
6.
go back to reference Douglas PS, Hoffmann U, Patel MR et al (2015) Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med 372:1291–1300CrossRefPubMedPubMedCentral Douglas PS, Hoffmann U, Patel MR et al (2015) Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med 372:1291–1300CrossRefPubMedPubMedCentral
7.
go back to reference Meijboom WB, Van Mieghem CA, van Pelt N et al (2008) Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol 52:636–643CrossRefPubMed Meijboom WB, Van Mieghem CA, van Pelt N et al (2008) Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol 52:636–643CrossRefPubMed
8.
go back to reference Schuijf JD, Wijns W, Jukema JW et al (2006) Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol 48:2508–2514CrossRefPubMed Schuijf JD, Wijns W, Jukema JW et al (2006) Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol 48:2508–2514CrossRefPubMed
9.
go back to reference Koo BK, Erglis A, Doh JH et al (2011) Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. results from the prospective multicenter DISCOVER-FLOW (diagnosis of ischemia-causing stenoses obtained via noninvasive fractional flow reserve) study. J Am Coll Cardiol 58:1989–1997CrossRefPubMed Koo BK, Erglis A, Doh JH et al (2011) Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. results from the prospective multicenter DISCOVER-FLOW (diagnosis of ischemia-causing stenoses obtained via noninvasive fractional flow reserve) study. J Am Coll Cardiol 58:1989–1997CrossRefPubMed
10.
go back to reference Norgaard BL, Leipsic J, Gaur S et al (2014) Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (analysis of coronary blood flow using CT angiography: next steps). J Am Coll Cardiol 63:1145–1155CrossRefPubMed Norgaard BL, Leipsic J, Gaur S et al (2014) Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (analysis of coronary blood flow using CT angiography: next steps). J Am Coll Cardiol 63:1145–1155CrossRefPubMed
11.
12.
go back to reference Min JK, Berman DS, Budoff MJ et al (2011) Rationale and design of the DeFACTO (determination of fractional flow reserve by anatomic computed tomographic AngiOgraphy) study. J Cardiovasc Comput Tomogr 5:301–309CrossRefPubMed Min JK, Berman DS, Budoff MJ et al (2011) Rationale and design of the DeFACTO (determination of fractional flow reserve by anatomic computed tomographic AngiOgraphy) study. J Cardiovasc Comput Tomogr 5:301–309CrossRefPubMed
13.
go back to reference Gaur S, Achenbach S, Leipsic J et al (2013) Rationale and design of the HeartFlowNXT (HeartFlow analysis of coronary blood flow using CT angiography: NeXt sTeps) study. J Cardiovasc Comput Tomogr 7:279–288CrossRefPubMed Gaur S, Achenbach S, Leipsic J et al (2013) Rationale and design of the HeartFlowNXT (HeartFlow analysis of coronary blood flow using CT angiography: NeXt sTeps) study. J Cardiovasc Comput Tomogr 7:279–288CrossRefPubMed
14.
go back to reference Abbara S, Arbab-Zadeh A, Callister TQ et al (2009) SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 3:190–204CrossRefPubMed Abbara S, Arbab-Zadeh A, Callister TQ et al (2009) SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 3:190–204CrossRefPubMed
15.
go back to reference Leipsic J, Abbara S, Achenbach S et al (2014) SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 8:342–358CrossRefPubMed Leipsic J, Abbara S, Achenbach S et al (2014) SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 8:342–358CrossRefPubMed
16.
go back to reference Agatston AS, Janowitz WR, Hildner FJ et al (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832CrossRefPubMed Agatston AS, Janowitz WR, Hildner FJ et al (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832CrossRefPubMed
17.
go back to reference Austen WG, Edwards JE, Frye RI et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51:5–40CrossRefPubMed Austen WG, Edwards JE, Frye RI et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51:5–40CrossRefPubMed
18.
go back to reference Tonino PA, De Bruyne B, Pijls NH et al (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360:213–224CrossRefPubMed Tonino PA, De Bruyne B, Pijls NH et al (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360:213–224CrossRefPubMed
19.
go back to reference De Bruyne B, Fearon WF, Pijls NH et al (2014) Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med 371:1208–1217CrossRefPubMed De Bruyne B, Fearon WF, Pijls NH et al (2014) Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med 371:1208–1217CrossRefPubMed
20.
go back to reference De Bruyne B, Pijls NH, Kalesan B et al (2012) Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 367:991–1001CrossRefPubMed De Bruyne B, Pijls NH, Kalesan B et al (2012) Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 367:991–1001CrossRefPubMed
21.
go back to reference Adjedj J, De Bruyne B, Flore V et al (2016) Significance of Intermediate Values of Fractional Flow Reserve in Patients With Coronary Artery Disease. Circulation 133:502–508CrossRefPubMed Adjedj J, De Bruyne B, Flore V et al (2016) Significance of Intermediate Values of Fractional Flow Reserve in Patients With Coronary Artery Disease. Circulation 133:502–508CrossRefPubMed
22.
go back to reference Task Force Members, Montalescot G, Sechtem U et al (2013) 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 34:2949–3003CrossRef Task Force Members, Montalescot G, Sechtem U et al (2013) 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 34:2949–3003CrossRef
23.
go back to reference Genders TS, Steyerberg EW, Alkadhi H et al (2011) A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension. Eur Heart J 32:1316–1330CrossRefPubMed Genders TS, Steyerberg EW, Alkadhi H et al (2011) A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension. Eur Heart J 32:1316–1330CrossRefPubMed
24.
go back to reference Leipsic J, Yang TH, Thompson A et al (2014) CT angiography (CTA) and diagnostic performance of noninvasive fractional flow reserve: results from the Determination of Fractional Flow Reserve by Anatomic CTA (DeFACTO) study. AJR Am J Roentgenol 202:989–994CrossRefPubMed Leipsic J, Yang TH, Thompson A et al (2014) CT angiography (CTA) and diagnostic performance of noninvasive fractional flow reserve: results from the Determination of Fractional Flow Reserve by Anatomic CTA (DeFACTO) study. AJR Am J Roentgenol 202:989–994CrossRefPubMed
25.
go back to reference Norgaard BL, Gaur S, Leipsic J, Ito H et al (2015) Influence of coronary calcification on the diagnostic performance of CT angiography derived FFR in coronary artery disease: a substudy of the NXT trial. JACC Cardiovasc Imaging 8:1045–1055CrossRefPubMed Norgaard BL, Gaur S, Leipsic J, Ito H et al (2015) Influence of coronary calcification on the diagnostic performance of CT angiography derived FFR in coronary artery disease: a substudy of the NXT trial. JACC Cardiovasc Imaging 8:1045–1055CrossRefPubMed
Metadata
Title
Feasibility and diagnostic performance of fractional flow reserve measurement derived from coronary computed tomography angiography in real clinical practice
Authors
Tetsuma Kawaji
Hiroki Shiomi
Hiroshi Morishita
Takeshi Morimoto
Charles A. Taylor
Shotaro Kanao
Koji Koizumi
Satoshi Kozawa
Kazuhisa Morihiro
Hirotoshi Watanabe
Junichi Tazaki
Masao Imai
Naritatsu Saito
Satoshi Shizuta
Koh Ono
Kaori Togashi
Takeshi Kimura
Publication date
01-02-2017
Publisher
Springer Netherlands
Published in
The International Journal of Cardiovascular Imaging / Issue 2/2017
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-016-0995-9

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