CT-Derived Fractional Flow Reserve (CT-FFR) in the Evaluation of Coronary Artery Disease

Khav, Nancy; Ihdayhid, Abdul Rahman; Ko, Brian

doi:10.1016/j.hlc.2020.05.099

Cited by 16 publications

(22 citation statements)

References 41 publications

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“…A recent detailed review of CTFFR by Khav et al stated that, while the evidence base for CTFFR is developing, further large-scale studies with cost-benefit analysis and long-term outcomes data are required to justify the additional costs of CTFFR in the Australian health care system. 13 Our own cost analysis demonstrates that CTFFR can be implemented in a more economical way with a £194.56 saving PP if CTFFR is only undertaken in patients with >50% CTCA stenosis as per ESC guidance. However, assuming that SE accuracy is equal to CTFFR, it can perform the same gatekeeping role at a further cost saving of £228.74 per patient.…”

Section: Discussionmentioning

confidence: 88%

NHS England-funded CT fractional flow reserve in the era of the ISCHEMIA trial

et al. 2021

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BackgroundThe National Institute for Health and Care Excellence (NICE) 2016 guidelines (CG95) recommend patients with new stable chest pain be investigated with computed tomography coronary angiography (CTCA). An updated guideline (MTG32) recommended using CT fractional flow reserve (CTFFR) as a gatekeeper to invasive coronary angiography (ICA) for patients with coronary stenosis on CTCA. Subsequently, NHS England negotiated a UK-wide contract with HeartFlow, the provider of CTFFR. We describe our experience with CTFFR and consider the impact of the recent ISCHEMIA trial on these guidelines. MethodsWe prospectively collected ICA and revascularisation data on all patients undergoing CTFFR from January 2019 to March 2020. ResultsOne-hundred and twenty-five of 140 patients completed CTFFR analysis. Eighty-one patients had CTCA stenosis >50%. Thirty-six had positive CTFFR; 29 underwent ICA with 22 (75.9%) revascularised. Forty-five had negative CTFFR; 14 underwent ICA and four (28.6%) were revascularised. The average cost of investigation per patient (PP) was £971.95. Had these patients undergone ICA directly with no functional test after CTCA, the average cost would be £932.51 PP. ConclusionOur revascularisation rates suggest that CTFFR can potentially be a gatekeeper to ICA but does not necessarily yield cost savings.

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Section: Discussionmentioning

confidence: 88%

NHS England-funded CT fractional flow reserve in the era of the ISCHEMIA trial

et al. 2021

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“…Then, the boundary conditions of the individual-specific hemodynamics are defined, and the boundary conditions are used to predict the flow and pressure, followed by a simulation for the hyperemic flow. 17,18 To date, the full-order CT-FFR program also incorporates ML methods in its model to analyze CCTA images and help create a personalized model for each patient. However, the processing of full-order CFD-based CT-FFR is computationally demanding and needs to be implemented off-site on supercomputers in core laboratories, limiting its routine clinical uses in some instances.…”

Section: Ct-ffr Techniques Principles and Workflows Of Ct-ffrmentioning

confidence: 99%

“…Overall, the sensitivity and specificity of CT-FFR at the per-vessel level were 76% to 98% and 61% to 94%, respectively. [18][19][20]23,24,26,28,29,[53][54][55][56][57][58][68][69][70]90,91 The MLbased CT-FFR and CFD-based CT-FFR showed similar performance in detecting lesion-specific ischemia. 28,70 CT-FFR performed better than conventional CCTA alone (Fig.…”

Section: The Clinical Evidence Of Ct-ffr Diagnostic Performance Of Ct...mentioning

confidence: 99%

“…5), mainly because of the improved specificity and positive predictive value of CT-FFR without sacrificing sensitivity. 18,92,93 Anatomic stenosis and functional ischemia are often mismatched in those patients with intermediate stenosis. For example, some lesions do not appear to be severe on angiography but can cause ischemia.…”

Section: The Clinical Evidence Of Ct-ffr Diagnostic Performance Of Ct...mentioning

confidence: 99%

“…The workflow of full-order CT-FFR can be summarized as follows: first, the major coronary vessels, as well as the corresponding branches and left ventricular myocardium are segmented and modeled from the conventional CCTA image datasets. Then, the boundary conditions of the individual-specific hemodynamics are defined, and the boundary conditions are used to predict the flow and pressure, followed by a simulation for the hyperemic flow 17,18. To date, the full-order CT-FFR program also incorporates ML methods in its model to analyze CCTA images and help create a personalized model for each patient.…”

Section: Ct-ffr Techniquesmentioning

confidence: 99%

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Coronary Computed Tomography Angiography–derived Fractional Flow Reserve

Zhang

Tang

et al. 2022

Journal of Thoracic Imaging

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Invasive fractional flow reserve (FFR) measured by a pressure wire is a reference standard for evaluating functional stenosis in coronary artery disease. Coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) uses advanced computational analysis methods to noninvasively obtain FFR results from a single conventional coronary computed tomography angiography data to evaluate the hemodynamic significance of coronary artery disease. More and more evidence has found good correlation between the results of noninvasive CT-FFR and invasive FFR. CT-FFR has proven its potential in optimizing patient management, improving risk stratification and prognosis, and reducing total health care costs. However, there is still a lack of standardized interpretation of CT-FFR technology in real-world clinical settings. This expert consensus introduces the principle, workflow, and interpretation of CT-FFR; summarizes the stateof-the-art application of CT-FFR; and provides suggestions and recommendations for the application of CT-FFR with the aim of promoting the standardized application of CT-FFR in clinical practice.

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Noninvasive computed tomography derived fractional flow reserve simulation based on microvascular tree model reconstruction

Wang

et al. 2022

Numer Methods Biomed Eng

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To establish a novel method for noninvasive computed tomography derived fractional flow reserve (CT‐FFR) simulation based on microvascular tree model reconstruction and to evaluate the feasibility and diagnostic performance of the novel method in coronary artery disease compared with invasive fractional flow reserve (FFR). Twenty patients (20 vessels) who underwent coronary computed tomography angiography (CCTA) and invasive FFR were retrospectively studied. The anatomic epicardial coronary artery model was reconstructed based on CCTA image, and the microvascular tree model was simulated based on patient‐specific anatomical structures and physiological principles. Numerical simulation was subsequently performed using the CFD method with full consideration of the variation of viscosity in microvascular. Two patients with the FFR value of .80 were selected for adjusting the parameters of the model, while the remaining 18 patients were selected as a validation cohort. After simulation, CT‐FFR was compared with invasive FFR with a threshold of .80. Eleven (55%) patients had an abnormal FFR that was less than or equal to .80. Compared with invasive FFR, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT‐FFR with an optimal threshold of .80 were 100%, 77.8%, 81.8%, 100%, 88.89%, respectively. There were a good correlation and consistency between CT‐FFR and invasive FFR. Time per patient of CT‐FFR analysis was less than 15 min. CT‐FFR based on microvascular tree model reconstruction is feasible with good diagnostic performance. It requires a short processing time with excellent accuracy. Large multicenter prospective studies are required for further demonstrating the diagnostic performance of this novel model in myocardium ischemia evaluation.

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CT-Derived Fractional Flow Reserve (CT-FFR) in the Evaluation of Coronary Artery Disease

Cited by 16 publications

References 41 publications

NHS England-funded CT fractional flow reserve in the era of the ISCHEMIA trial

NHS England-funded CT fractional flow reserve in the era of the ISCHEMIA trial

Coronary Computed Tomography Angiography–derived Fractional Flow Reserve

Noninvasive computed tomography derived fractional flow reserve simulation based on microvascular tree model reconstruction

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