Assessment of lesion-specific ischemia using fractional flow reserve (FFR) profiles derived from coronary computed tomography angiography (FFRCT) and invasive pressure measurements (FFRINV): Importance of the site of measurement and implications for patient referral for invasive coronary angiography and percutaneous coronary intervention

Cami, Elvis; Tagami, Travis; Raff, Gilbert; Fonte, Timothy A.; Renard, Brian M.; Gallagher, Michael J.; Chinnaiyan, Kavitha M.; Bilolikar, Abhay; Fan, Austin; Hafeez, Adam; Safian, Robert D.

doi:10.1016/j.jcct.2018.09.003

Cited by 37 publications

(39 citation statements)

References 40 publications

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“…One of the reasons is that there is a gradual decrease in both CT-derived FFR and invasive FFR value with distance, even without stenosis, due to pressure loss by frictional losses according to Poiseulle’s equation [14] . The influence is reportedly more significant in CT-derived FFR than invasive FFR [15] .…”

Section: Discussionmentioning

confidence: 93%

Comparison of diagnostic performance in on-site based CT-derived fractional flow reserve measurements

Nozaki

Fujimoto

Aoshima

et al. 2021

IJC Heart & Vasculature

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Background Computed tomography fractional flow reserve (CT-FFR), which can be acquired on-site workstation using fluid structure interaction during the multiple optimal diastolic phase, has an incremental diagnostic value over conventional coronary computed tomography angiography (CCTA). However, the appropriate location for CT-FFR measurement remains to be clarified. Method A total of 115 consecutive patients with 149 vessels who underwent CCTA showing 30–90% stenosis with invasive FFR within 90 days were retrospectively analyzed. CT-FFR values were measured at three points: 1 and 2 cm distal to the target lesion (CT-FFR 1cm, 2cm ) and the vessel terminus (CT-FFR lowest ). The diagnostic accuracies of CT-FFR ≤ 0.80 for detecting hemodynamically significant stenosis, defined as invasive FFR ≤ 0.80, were compered. Result Fifty-five vessels (36.9%) had invasive FFR ≤ 0.80. The accuracy and AUC for CT-FFR 1cm and 2cm were comparable, while the AUC for CT-FFR lowest was significantly lower than CT-FFR 1cm and 2cm . (lowest/1cm, 2 cm = 0.68 (95 %CI 0.63–0.73) vs 0.79 (0.72–0.86, p = 0.006), 0.80 (0.73–0.87, p = 0.002)) The sensitivity and negative predictive value of CT-FFR lowest were 100%. The reclassification rates from positive CT-FFR lowest to negative CT-FFR 1cm and 2cm were 55.7% and 54.2%, respectively. Conclusion The diagnostic performance of CT-FFR was comparable when measured at 1-to-2 cm distal to the target lesion, but significantly higher than CT-FFR lowest . The lesion-specific CT-FFR could reclassify false positive cases in patients with positive CT-FFR lowest , while all patients with negative CT-FFR lowest were diagnosed as negative by invasive FFR.

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Section: Discussionmentioning

confidence: 93%

Comparison of diagnostic performance in on-site based CT-derived fractional flow reserve measurements

Nozaki

Fujimoto

Aoshima

et al. 2021

IJC Heart & Vasculature

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“…dilatation, resulting in reduced flow velocity and pressure recovery (Fig 3). In a recent study, it was suggested that a reliable location at which to assess FFR CT was 1 cm distal to the end of a stenosis (36). For clinical decision making, we recommend using the FFR CT value 1-2 cm distal to the lower border of the stenosis, avoiding the pressure recovery phenomenon.…”

Section: Key Pointsmentioning

confidence: 99%

“…Distal Vessel FFR CT Values FFR CT provides simultaneous computation of pressure and flow in the entire coronary tree, thus exposing both lesion-specific pressure as well as nadir FFR CT values across the coronary system, which in various settings may drop less than or equal to 0.80 (14,19,(34)(35)(36) (Fig 1). Low terminal vessel FFR CT values (rather than a value distal to stenosis) may include effects unrelated to the stenosis (19,(35)(36)(37). These low values remote from a focal lesion may be due to diffuse CAD or reflect the sum of serial flow-limiting lesions (35)(36)(37).…”

Section: Nørgaard Et Almentioning

confidence: 99%

“…Low terminal vessel FFR CT values (rather than a value distal to stenosis) may include effects unrelated to the stenosis (19,(35)(36)(37). These low values remote from a focal lesion may be due to diffuse CAD or reflect the sum of serial flow-limiting lesions (35)(36)(37). In recent studies, 35%-44% of patients with stable CAD and terminal vessel FFR CT values less than or equal to 0.80 were reclassified as negative when the FFR CT point of reading was 1-2 cm distal to stenosis (14,35).…”

Section: Nørgaard Et Almentioning

confidence: 99%

“…In patients with CAD, as for measured FFR, FFR CT values decline from the ostium to the distal vessel irrespective of the vessel territory, stenosis severity, and location (14,19,(34)(35)(36). In FFR practice, it is advised that the FFR value within the throat of the lesion (which may correspond to the minimum FFR CT value) is not used clinically and that the pressure is assessed at least 2-3 cm distal to the stenosis of interest (20).…”

Section: Standardized Interpretation Of Hemodynamically Significant Lmentioning

confidence: 99%

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Coronary CT Angiography-derived Fractional Flow Reserve Testing in Patients with Stable Coronary Artery Disease: Recommendations on Interpretation and Reporting

Nørgaard¹,

Fairbairn²,

Safian³

et al. 2019

Radiology: Cardiothoracic Imaging

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Noninvasive fractional flow reserve derived from coronary CT angiography (FFR CT ) is increasingly used in patients with coronary artery disease as a gatekeeper to the catheterization laboratory. While there is emerging evidence of the clinical benefit of FFR CT in patients with moderate coronary disease as determined with coronary CT angiography, there has been less focus on interpretation, reporting, and integration of FFR CT results into routine clinical practice. Because FFR CT analysis provides a plethora of information regarding pressure and flow across the entire coronary tree, standardized criteria on interpretation and reporting of the FFR CT analysis result are of crucial importance both in context of the clinical adoption and in future research. This report represents expert opinion and recommendation on a standardized FFR CT interpretation and reporting approach.Published under a CC BY 4.0 license.

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Diagnostic performance of corrected FFRCT metrics to predict hemodynamically significant coronary artery stenosis

et al. 2021

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Cited by 37 publications

References 40 publications

Comparison of diagnostic performance in on-site based CT-derived fractional flow reserve measurements

Comparison of diagnostic performance in on-site based CT-derived fractional flow reserve measurements

Coronary CT Angiography-derived Fractional Flow Reserve Testing in Patients with Stable Coronary Artery Disease: Recommendations on Interpretation and Reporting

Diagnostic performance of corrected FFRCT metrics to predict hemodynamically significant coronary artery stenosis

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