Clinical Use of CT-Derived Fractional Flow Reserve in the Emergency Department

Chinnaiyan, Kavitha M.; Safian, Robert D.; Gallagher, Michael; George, Julie; Dixon, Simon; Bilolikar, Abhay; Abbas, Amr E.; Shoukfeh, Mazen; Brodsky, Marc; Stewart, James T.; Cami, Elvis; Forst, David; Timmis, Steven B.H.; Crile, Jason; Raff, Gilbert

doi:10.1016/j.jcmg.2019.05.025

Cited by 52 publications

(45 citation statements)

References 20 publications

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“…Recently, the first study evaluating the use of FFR CT within the acute chest pain population was published. Chinnaiyan et al compared a strategy of CCTA alone vs CCTA + FFR CT in patients presenting to the ED with acute chest pain [28]. A total of 555 patients were included in the cohort with 297 patients undergoing CCTA + FFR CT and 258 patients undergoing CCTA only [28].…”

Section: Discussionmentioning

confidence: 99%

Non-invasive fractional flow reserve (FFRCT) in the evaluation of acute chest pain – Concepts and first experiences

Fischer

Assen

Schoepf

et al. 2021

European Journal of Radiology

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Section: Discussionmentioning

confidence: 99%

Non-invasive fractional flow reserve (FFRCT) in the evaluation of acute chest pain – Concepts and first experiences

Fischer

Assen

Schoepf

et al. 2021

European Journal of Radiology

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“…Initial rejection rates for FFRCT analysis reported throughout the literature range from 13% to 33%, with significant cardiac motion commonly cited as a reason for rejection [ 4 , 6 ]. Pontone et al found that temporal resolution, section thickness, and heart rate are independent predictors of rejection for CCTA FFRCT analysis [ 5 , 9 ]. They postulated that their own study had a low rejection rate of 2.9% because of the use of dual-source technology and wide-coverage single-source scanners.…”

Section: Discussionmentioning

confidence: 99%

Improving CT-Derived Fractional Flow Reserve Analysis: A Quality Improvement Initiative

Waltz

Kocher

Kahn

et al. 2020

Cureus

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Objectives The aim of this study was to identify factors and quality improvement strategies to improve coronary computed tomography angiography (CCTA) studies referred for fractional flow reserve derived from CT angiography (FFRCT) analysis. Methods Thirty randomly selected CCTAs were analyzed for quality control. A uniform CCTA protocol was implemented by an in-house steering committee, emphasizing the importance of adequate heart rate control and nitroglycerine usage. Sixty additional randomly selected CCTAs were evaluated for quality at multiple time points during intervention, and FFRCT acceptance rate was analyzed at the conclusion. Results Prior to the implementation of this quality improvement program, our overall institution-specific percent acceptance rate was 76.1% for FFRCT compared to the national average of >95%. Post-intervention, this was improved to an average acceptance rate of 90% for FFRCT analysis. Conclusions Establishment and strict adherence to CCTA imaging protocols with appropriate training and adequate buy-in of CT technologists and nurses is a viable way of improving the quality of imaging and subsequent patient care.

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“…In contrast, a more recent study by Chinnaiyan et al applying a newer off-site FFR-CT algorithm (Heartflow, Inc.) found a rejection rate of 1.6% with no differences in MACE between CTA and FFR-CT groups (4.3% vs 2.7%, p ¼ NS) and deferral of revascularization with a negative FFR-CT was associated with a higher rate (56.5%) of non-obstructive CAD on invasive angiography than positive FFR-CT (8.0%) or coronary CTA (22.9%; p < 0.001). 53 The need for rapid decision-making may make sending a study for off-site analysis with a 2-3 h turn around time undesirable. A smaller contemporary cohort notes of on-site machine-learning based FFR-CT (cFFR, Siemens Healthineers) that for 32% of patients the CT was not deemed to be technically feasible attributed to higher median heart rate (median 81 bpm), but no significant differences in calcium score (median 167 vs 156 in feasible and non-feasible patients).…”

Section: Fractional Flow Reserve By Computed Tomographymentioning

confidence: 99%

“…The cost, validity, and processing time to perform novel approaches of plaque quantification such as perivascular fat inflammation, and functional approaches such as CTP and CT-FFR remain unclear, but hold important promise. 53,55 These approaches require assurance of high image quality.…”

Section: Limitations Of Ccta In Acsmentioning

confidence: 99%

The evolving role of coronary CT angiography in Acute Coronary Syndromes

Kumar

Weerakoon

Dey

et al. 2021

Journal of Cardiovascular Computed Tomography

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In the United States, non-obstructive coronary disease has been on the rise, and each year, nearly one million adults suffer myocardial infarction, 70% of which are non-ST-segment elevation myocardial infarction (NSTEMI). In addition, approximately 15% of patients suffering NSTEMI will have subsequent readmission for a recurrent acute coronary syndrome (ACS). While invasive angiography remains the standard of care in the diagnostic and therapeutic approach to these patients, these methods have limitations that include procedural complications, uncertain specificity in diagnosis of the culprit lesion in patients with multi-vessel coronary artery disease (CAD), and challenges in following coronary disease over time. The role of coronary computed tomography angiography (CCTA) for evaluating patients with both stable and acute chest pain has seen a paramount upshift in the last decade. This paper reviews the established role of CCTA for the rapid exclusion of obstructive plaque in troponin negative acute chest pain, while exploring opportunities to address challenges in the current approach to evaluating NSTEMI.

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Clinical Use of CT-Derived Fractional Flow Reserve in the Emergency Department

Cited by 52 publications

References 20 publications

Non-invasive fractional flow reserve (FFRCT) in the evaluation of acute chest pain – Concepts and first experiences

Non-invasive fractional flow reserve (FFRCT) in the evaluation of acute chest pain – Concepts and first experiences

Improving CT-Derived Fractional Flow Reserve Analysis: A Quality Improvement Initiative

The evolving role of coronary CT angiography in Acute Coronary Syndromes

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