Clinical Impact of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Japanese Population in the ADVANCE Registry

Shiono, Yasutsugu; Matsuo, Hitoshi; Kawasaki, Terukazu; Amano, Tetsuya; Kitabata, Hironori; Kubo, Takashi; Morino, Yoshihiro; Yoda, Shunichi; Sakamoto, Tomohiro; Ito, Hiroshi; Shite, Junya; Otake, Hiromasa; Tanaka, Nobuhiro; Terashima, Mitsuyasu; Kadota, Kazushige; Patel, Manesh R.; Nieman, Koen; Rogers, Campbell; Nørgaard, Bjarne Linde; Bax, Jeroen J.; Raff, Gilbert; Chinnaiyan, Kavitha M.; Berman, Daniel S.; Fairbairn, Timothy A.; Koweek, Lynne M. Hurwitz; Leipsic, Jonathon

doi:10.1253/circj.cj-18-1269

Cited by 10 publications

(5 citation statements)

References 31 publications

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“…When stratified by FFRCT, similar rates of revascular- of core laboratory-determined treatment plans. 6 The reclassification rate was lower in the present study for non-AUC sites, likely reflecting the lower anatomical coronary disease burden identified on CCTA, with lower rates of anatomical stenosis at non-AUC sites. These findings are in agreement with the growing clinical evidence regarding the use of CCTA in clinical practice, where CCTA has been shown to be a powerful tool for the detection or exclusion of anatomical coronary disease but unable to adjudicate the physiological significance of CAD.…”

Section: Downstream Clinical Treatment Stratified By Ffrctcontrasting

confidence: 50%

“…For example, a positive FFRCT result was associated with higher rates of ICA showing obstructive CAD and subsequent coronary revascularization, whereas patients with a negative FFRCT result were managed with medical therapy and deferral of ICA, with demonstrable favorable short-term clinical outcomes. 6 FFRCT has recently received funding and support from the Ministry of Health, Labour and Welfare (MHLW) in Japan, but only at approved sites that have satisfied the hospital conditions required by appropriate use criteria (AUC) defined by the MHLW. AUC sites are defined by the MHLW as training facilities of the Japanese Circulation Society (JCS), Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), and Japan Radiological Society (JRS).…”

Section: Discussionmentioning

confidence: 99%

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Effect of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Physicians’ Clinical Behavior　― Differences Between Sites With and Without Appropriate Use Criteria as Designated by the Japanese Reimbursement System ―

et al. 2020

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Background: Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) is an established tool for identifying lesion-specific ischemia that is now approved for use by the Japanese insurance system. However, current clinical reimbursement is strictly limited to institutions with designated appropriate use criteria (AUC). This study assessed differences in physicians' behavior (e.g., use and interpretation of FFRCT, final management) according to Japanese AUC and non-AUC site designation. Methods and Results: Of 5,083 patients in the ADVANCE Registry, 1,829 from Japan were enrolled in this study. Physicians' behavior after interrogating CCTA and FFRCT was analyzed separately according to AUC and non-AUC site designation. Compared with AUC sites, patients referred for FFRCT from non-AUC sites had a higher rate of negative FFRCT, less severe anatomic stenosis, and a slightly lower rate of management plan reclassification (51.2% vs. 61.3%), with near-identical utility in both groups. Actual care corresponded equally well to post-FFRCT plans in both groups. The likelihood of revascularization for positive or negative FFRCT was similar between the 2 groups. Importantly, AUC and non-AUC sites were equally unlikely to revascularize patients with negative FFRCT and stenosis >50% or patients with positive FFRCT and stenosis <50%. Conclusions: Compared with AUC sites, non-AUC sites had lower disease burden and reclassification of management plans, but nearly identical clinical integration. Actual care corresponded equally well to post-FFRCT recommendations at both sites.

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Section: Downstream Clinical Treatment Stratified By Ffrctcontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Effect of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Physicians’ Clinical Behavior　― Differences Between Sites With and Without Appropriate Use Criteria as Designated by the Japanese Reimbursement System ―

et al. 2020

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“…With FFR set as the baseline, a study showed that QFR had a positive discovery rate of 81% and a negative predictive value (NPV) of 90%, whereas CT-FFR had a positive predictive value (PPV) of 70% and an NPV of 82% ( 41 ). Despite the better potential in diagnostic accuracy of QFR, by contrast, CT-FFR is more appropriate for outpatients without evident coronary syndrome to reduce unnecessary ICA ( 55 ).…”

Section: Discussionmentioning

confidence: 99%

Science mapping analysis of computed tomography-derived fractional flow reverse: a bibliometric review from 2012 to 2022

Zhang,

Zhu,

Jiang

et al. 2023

Quant Imaging Med Surg

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Background Computed tomography-derived fractional flow reserve (CT-FFR) is a non-invasive imagological examination used for diagnosing suspected coronary atherosclerotic heart disease, providing the morphological and functional value on a three-dimensional (3D) coronary artery model. This article aimed to collate the existing knowledge and predict this novel technology’s future research hotspots. Methods To collect data, 1,712 articles were retrieved from the Web of Science Core Collection (WoSCC) database from 2012–2022. CiteSpace5.8.R3 was used to visually analyze the research status and predict future research hotspots. Results Firstly, the United States, China, and the Netherlands were identified as the countries having published the most articles about CT-FFR. Jonathan Leipsic’s group ranked first for the highest number of published articles. Secondly, the visualized analysis indicated that the exploration of CT-FFR is multi-disciplinary and involves cardiology, radiology, engineering, and computer science. Thirdly, the hotspots in this field, which were inferred from the keyword distribution and clustering, included the following: “diagnostic performance”, “accuracy”, and the “prognostic value” of CT-FFR, and comparison of CT-FFR and other imaging methods sharing similarities. The research frontiers included technologies utilized to obtain more accurate CT-FFR values, such as artificial intelligence (AI) and deep learning. Conclusions As the first visualized bibliometric analysis on CT-FFR, this study captured the current accumulated information in this field and offer more insight and guidance for future research.

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“…As a noninvasive test following CCTA, FFR CT assesses functional severity by utilizing computational fluid dynamics to calculate coronary blood flow, and exhibits good correlation with invasive FFR 16 . The utility of FFR CT has been demonstrated in several studies of patients with suspected CAD and CAS, and FFR CT ≤0.80 was used as a predictive indicator with functional significance 16‐18 . Data on clinical outcomes in association with FFR CT are limited compared to the diagnostic data.…”

Section: Discussionmentioning

confidence: 99%

“… 16 The utility of FFR CT has been demonstrated in several studies of patients with suspected CAD and CAS, and FFR CT ≤0.80 was used as a predictive indicator with functional significance. 16 , 17 , 18 Data on clinical outcomes in association with FFR CT are limited compared to the diagnostic data. Therefore, the FFR CT analysis was performed in patients with CAS determined using CCTA among a cohort of patients with suspected CAD in the present study, and the utility of FFR CT in predicting downstream clinical outcomes was examined.…”

Section: Discussionmentioning

confidence: 99%

Combination of coronary CT angiography, FFR_CT, and risk factors in the prediction of major adverse cardiovascular events in patients suspected CAD

Wada

Iwanaga

Nakai

et al. 2023

Clinical Cardiology

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Background To examine the utility of fractional flow reserve by coronary computed tomography (CT) angiography (FFRCT) for predicting major adverse cardiovascular events (MACE) in patients with suspected coronary artery disease (CAD). Methods This was a nationwide multicenter prospective cohort study including consecutive 1187 patients aged 50−74 years with suspected CAD and had available coronary CT angiography (CCTA). In patients with ≥50% coronary artery stenosis (CAS), FFRCT was further analyzed. The Cox proportional hazards model was used to examine the association of FFRCT and cardiovascular risk factors with incident MACE within 2 years. Results Among 933 patients with available information on MACE within 2 years after enrollment, the incidence rate of MACE was higher in 281 patients with CAS than in those without CAS (6.11 vs. 1.16 per 100 patient‐year). In 241 patients with CAS, the Cox proportional hazards analysis showed that FFRCT as well as diabetes mellitus and low high‐density lipoprotein cholesterol level were independently associated with incident MACE. Moreover, the hazard ratio was significantly higher in patients harboring all three factors compared to those harboring 0−2 of the three factors (6.01; 95% confidence interval: 2.77−13.03). Conclusions Combinatorial assessment using CCTA for stenosis, FFRCT, and risk factors was useful for more accurate prediction of MACE in patients with suspected CAD. Among patients with CAS, those with lower FFRCT, diabetes mellitus, and low high‐density lipoprotein cholesterol level were at highest risk for MACE during the 2‐year period following enrollment.

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Clinical Impact of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Japanese Population in the ADVANCE Registry

Cited by 10 publications

References 31 publications

Effect of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Physicians’ Clinical Behavior　― Differences Between Sites With and Without Appropriate Use Criteria as Designated by the Japanese Reimbursement System ―

Effect of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Physicians’ Clinical Behavior　― Differences Between Sites With and Without Appropriate Use Criteria as Designated by the Japanese Reimbursement System ―

Science mapping analysis of computed tomography-derived fractional flow reverse: a bibliometric review from 2012 to 2022

Combination of coronary CT angiography, FFR_CT, and risk factors in the prediction of major adverse cardiovascular events in patients suspected CAD

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Clinical Impact of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Japanese Population in the ADVANCE Registry

Cited by 10 publications

References 31 publications

Effect of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Physicians’ Clinical Behavior ― Differences Between Sites With and Without Appropriate Use Criteria as Designated by the Japanese Reimbursement System ―

Effect of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Physicians’ Clinical Behavior ― Differences Between Sites With and Without Appropriate Use Criteria as Designated by the Japanese Reimbursement System ―

Science mapping analysis of computed tomography-derived fractional flow reverse: a bibliometric review from 2012 to 2022

Combination of coronary CT angiography, FFRCT, and risk factors in the prediction of major adverse cardiovascular events in patients suspected CAD

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Effect of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Physicians’ Clinical Behavior　― Differences Between Sites With and Without Appropriate Use Criteria as Designated by the Japanese Reimbursement System ―

Effect of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Physicians’ Clinical Behavior　― Differences Between Sites With and Without Appropriate Use Criteria as Designated by the Japanese Reimbursement System ―

Combination of coronary CT angiography, FFR_CT, and risk factors in the prediction of major adverse cardiovascular events in patients suspected CAD