Locally computed CT-FFR based on fluid structure interaction has excellent diagnostic accuracy to detect a significant FFR ≤0.8 compared with conventional CCTA and high reproducibility.

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Background: The optimal site for measuring computed tomography (CT)-derived fractional flow reserve (FFR CT ) to detect significant coronary artery disease (CAD) remains unknown. We investigated how diagnostic performance changes with FFR CT measurement site. Methods and Results: The diagnostic performance of FFR CT , measured 1–2 cm distal to the stenosis vs. a far-distal site, in detecting significant CAD with invasive fractional flow reserve ≤0.8 was evaluated in 254 diseased vessels from 146 patients with stable or suspected CAD diagnosed by coronary CT angiography. Receiver operating characteristic curve analysis revealed a significantly larger area under the curve for FFR CT measured 1–2 cm distal to the stenosis than at a far-distal site (0.829 vs. 0.791, respectively; P=0.0305). The rate of reclassification of positive FFR CT was 19% for measurements made 1–2 cm distal to the stenosis, and diagnostic accuracy for FFR CT 0.71–0.80 improved from 36% to 58% (P=0.0052). Vessel-based diagnostic accuracy of FFR CT 1–2 cm distal to the stenosis and at a far-distal site was 75% and 65%, respectively (P<0.0001), with corresponding sensitivity of 87% and 94% (P=0.0039), specificity of 60% and 29% (P<0.0001), a positive predictive value of 73% and 62% (P=0.028), and a negative predictive value of 78% and 79% (P=0.958). Conclusions: Our data suggest measuring FFR CT 1–2 cm distal to the stenosis has better diagnostic performance for detecting physiologically significant CAD.

normal left ventricular wall motion, while CCTA using a 320-row CT (Aquillion ONE, Toshiba Medical Systems, Ohtawara, Japan) showed severe stenosis in the distal left main trunk (LMT) bifurcation (Figure 1). In this case, adenosine 201 Tl-myocardial perfusion imaging (MPI) showed no apparent perfusion defects in the left coronary area on MPI/CT fusion image (Figure 1) with summed stress score 2, summed rest score 0, and no transient ischemic dilatation. The washout rate of the present patient for adenosine 201 Tl-myocardial perfusion image was 44.68% which was slightly lower than the normal washout rate of the present institution ( Figure S1). This indicated no myocardial ischemia. On FFRCT analysis, however, FFR of the H emodynamic assessment of coronary artery disease (CAD) is important for performing appropriate percutaneous coronary intervention (PCI). Fractional flow reserve on computed tomography (FFRCT) is a new technology provided by HeartFlow. This is an epoch-making analytical method that allows the data from standard coronary computed tomography angiography (CCTA) to yield hemodynamic assessment of CAD without invasive procedures. 1A 58-year-old woman with risk factors of type 2 diabetes mellitus and dyslipidemia developed chest discomfort on mild effort. Electrocardiography showed complete right bundle block, and ultrasound cardiography showed a IMAGES IN CARDIOVASCULAR MEDICINEAdvance Publication by-J-STAGE

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