Adjustment of CT-fractional flow reserve based on fluid–structure interaction underestimation to minimize 1-year cardiac events

Katô, Etsurô; Fujimoto, Shinichiro; Kumamaru, Kanako K.; Kawaguchi, Yuko; Dohi, Tomotaka; Aoshima, Chihiro; Kamo, Yuki; Takamura, Kazuhisa; Kato, Yoshiteru; Hiki, Makoto; Okai, Iwao; Okazaki, Shinya; Aoki, Shigeki; Daida, Hiroyuki

doi:10.1007/s00380-019-01480-4

Cited by 6 publications

(2 citation statements)

References 23 publications

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“…Since the specificity of CT-FFR has previously been reported to be lower than the sensitivity using invasive FFR as a reference [12,13], unnecessary revascularization may result in an increase in false positive cases only, based on the results of CT-FFR. To overcome this problem, we reported the influence of pre-test probability on diagnostic performance as well as improvements in diagnostic performance using the correction formula for CT-FFR [24], and we also demonstrated that the strongest factor associated with false positivity was the presence of calcification [15]. Thus, we hypothesized that false positivity may be reduced by analyzing CT-FFR in images from which coronary arterial calcification had been removed using the subtraction method, particularly in cases with severe calcification.…”

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confidence: 99%

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Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study

Kamo

Fujimoto

Nozaki

et al. 2021

JCM

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Although on-site workstation-based CT fractional flow reserve (CT-FFR) is an emerging method for assessing vessel-specific ischemia in coronary artery disease, severe calcification is a significant factor affecting CT-FFR’s diagnostic performance. The subtraction method significantly improves the diagnostic value with respect to anatomic stenosis for patients with severe calcification in coronary CT angiography (CCTA). We evaluated the diagnostic capability of CT-FFR using the subtraction method (subtraction CT-FFR) in patients with severe calcification. This study included 32 patients with 45 lesions with severe calcification (Agatston score >400) who underwent both CCTA and subtraction CCTA using 320-row area detector CT and also received invasive FFR within 90 days. The diagnostic capabilities of CT-FFR and subtraction CT-FFR were compared. The sensitivities, specificities, positive predictive values (PPVs), and negative predictive values (NPVs) of CT-FFR vs. subtraction CT-FFR for detecting hemodynamically significant stenosis, defined as FFR ≤ 0.8, were 84.6% vs. 92.3%, 59.4% vs. 75.0%, 45.8% vs. 60.0%, and 90.5% vs. 96.0%, respectively. The area under the curve for subtraction CT-FFR was significantly higher than for CT-FFR (0.84 vs. 0.70) (p = 0.04). The inter-observer and intra-observer variabilities of subtraction CT-FFR were 0.76 and 0.75, respectively. In patients with severe calcification, subtraction CT-FFR had an incremental diagnostic value over CT-FFR, increasing the specificity and PPV while maintaining the sensitivity and NPV with high reproducibility.

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Section: Discussionmentioning

confidence: 99%

“…CT-FFR was calculated for the original and the subtracted data. CT-FFR was calculated using a previously reported method [ 11 , 12 , 15 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study

Kamo

Fujimoto

Nozaki

et al. 2021

JCM

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Plaque characteristics on coronary CT angiography associated with the positive findings of fractional flow reserve and instantaneous wave-free ratio

et al. 2020

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Background:Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are useful in determining indications for revascularization of coronary artery disease (CAD).Although the discordance of FFR and iFR was noted in approximately 20%, this cause has not been well established. We investigated patient background and features on coronary CT angiography (CCTA) showing not only FFR-and iFR-positive findings but also discordance between FFR≤0.8 and iFR≤0.89. Methods：Subjects were consecutive 83 cases with 105 vessels in which stenosis of 30-90% was detected at one vessel of at least 2mm or more in the major epicardial vessels and FFR and iFR was performed within subsequent 90 days, among suspected CAD which underwent CCTA. The factors affecting not only FFR-and iFR-positive findings respectively but also discordance between FFR and iFR were evaluated using logistic regression analysis on per-patient and per-vessel basis. 4 Results:FFR-and iFR-positive findings were observed in 42 vessels (40.0%) and 34 vessels (32.3%) respectively. Discordance between FFR≤0.8 and iFR≤0.89 was observed in 22 vessels (21.0%) of 21 patients. In multivariate logistic analysis, LAD (OR, 3.55; 95%CI, p=0.0217) and lumen volume/myocardial weight (L/M) ratio (OR, 0.93; 0.86-0.99, p=0.0290) were significant predictors for FFR positive findings. For iFR positive findings, LAD (OR, 3.86; 95%CI, 1.12-13.31; p=0.0236) was only significant predictor. In FFR≤0.8 and iFR>0.89 group (15 vessels, 14.3%), positive remodeling (PR) (OR 5.03, p=0.0205) were significant predictors. In FFR>0.8 and iFR≤0.89 group (7 vessels, 6.7%), there were no significant predictors. Conclusions：On CCTA characteristics, a relevant predictor for FFR positive findings included low L/M ratio. PR were significant predictor in FFR-positive, iFR-negative patients among those with discordance between the FFR and iFR.

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The diagnostic performance of on-site workstation-based computed tomography-derived fractional flow reserve. Comparison with myocardium perfusion imaging

et al. 2021

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Adjustment of CT-fractional flow reserve based on fluid–structure interaction underestimation to minimize 1-year cardiac events

Cited by 6 publications

References 23 publications

Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study

Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study

Plaque characteristics on coronary CT angiography associated with the positive findings of fractional flow reserve and instantaneous wave-free ratio

The diagnostic performance of on-site workstation-based computed tomography-derived fractional flow reserve. Comparison with myocardium perfusion imaging

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