Diagnostic accuracy and discrimination of ischemia by fractional flow reserve CT using a clinical use rule: Results from the Determination of Fractional Flow Reserve by Anatomic Computed Tomographic Angiography study

Thompson, Angus G; Raju, Rekha; Blanke, Philipp; Yang, Tae–Hyun; Mancini, G.B. John; Budoff, Matthew J.; Nørgaard, Bjarne Linde; Min, James K.; Leipsic, Jonathon

doi:10.1016/j.jcct.2015.01.008

Cited by 21 publications

(14 citation statements)

References 38 publications

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“…CTA was performed using CTA scanners, however, with a minimum of 64 detector rows in multiple centers for NXT trial [ 19 ]. The CTA scanner information was not provided in [ 19 ], but the scanners were listed as LightSpeed VCT/Discovery from GE, SOMATOM Sensation and Definition from Siemens, Brilliance 256 and 64 from Philips, Aquilion ONE and 64 from Toshiba in [ 41 ] for DeFACTO trial. Because Toshiba Aquilion CT scanners have finer detector elements of 0.5 mm than many other CT scanners (GE LightSpeed VCT: 0.625mm; Siemens Sensation 64: 0.6mm; Philips Brilliance 64: 0.625mm), the scanner used in this pilot study might have higher image resolution than some of the centers participating in the NXT trial and the image quality may have been better and more consistent.…”

Section: Discussionmentioning

confidence: 99%

Simplified Models of Non-Invasive Fractional Flow Reserve Based on CT Images

et al. 2016

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Invasive fractional flow reserve (FFR) is the gold standard to assess the functional coronary stenosis. The non-invasive assessment of diameter stenosis (DS) using coronary computed tomography angiography (CTA) has high false positive rate in contrast to FFR. Combining CTA with computational fluid dynamics (CFD), recent studies have shown promising predictions of FFRCT for superior assessment of lesion severity over CTA alone. The CFD models tend to be computationally expensive, however, and require several hours for completing analysis. Here, we introduce simplified models to predict noninvasive FFR at substantially less computational time. In this retrospective pilot study, 21 patients received coronary CTA. Subsequently a total of 32 vessels underwent invasive FFR measurement. For each vessel, FFR based on steady-state and analytical models (FFRSS and FFRAM, respectively) were calculated non-invasively based on CTA and compared with FFR. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 90.6% (87.5%), 80.0% (80.0%), 95.5% (90.9%), 88.9% (80.0%) and 91.3% (90.9%) respectively for FFRSS (and FFRAM) on a per-vessel basis, and were 75.0%, 50.0%, 86.4%, 62.5% and 79.2% respectively for DS. The area under the receiver operating characteristic curve (AUC) was 0.963, 0.954 and 0.741 for FFRSS, FFRAM and DS respectively, on a per-patient level. The results suggest that the CTA-derived FFRSS performed well in contrast to invasive FFR and they had better diagnostic performance than DS from CTA in the identification of functionally significant lesions. In contrast to FFRCT, FFRSS requires much less computational time.

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Section: Discussionmentioning

confidence: 99%

Simplified Models of Non-Invasive Fractional Flow Reserve Based on CT Images

et al. 2016

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“…11,18 Vessels with FFR >0.8 or without FFR measurement and ≤25% DS at ICA were considered negative. 17 Vessels with intermediate stenosis (26-89% DS) and no FFR measurement were excluded from analysis, as hemodynamic significance is uncertain. 14 Based on physiological flow characteristics of different coronary arteries, 15 and given the limitations of our study cohort (see "Results"), the receiver operating characteristic (ROC) area under the curve (AUC) to predict hemodynamically significant CAD using TAG as the diagnostic variable was calculated for (a) all arteries pooled together, (b) all LAD plus right-dominant LCX arteries and (c) right-dominant RCA plus left-dominant LCX arteries.…”

Section: Tag Measurementsmentioning

confidence: 99%

The transluminal attenuation gradient in coronary CT angiography for the detection of hemodynamically significant disease: can all arteries be treated equally?

Fujimoto

Giannopoulos

Kumamaru

et al. 2018

BJR

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Incorporating information on the physiology of coronary flow via the particular vessel interrogated and coronary dominance may improve the accuracy of TAG, a simple measurement that can be quickly performed at the time of CCTA interpretation to detect hemodynamically significant stenosis in individual coronary arteries. Advances in knowledge: The interpretation of TAG may benefit by incorporating information regarding which coronary artery is being interrogated.

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“…The ability to combine both an anatomical and functional test is extremely appealing, and this technology is well validated in terms of accuracy and safety ( Table 2). [30][31][32][33] Invasive FFR is a well-established technique for quantifying lesion-specific ischaemia, and is comparable to functional imaging. 34 To date, no trials with large numbers of patients have presented a comparison of myocardial functional imaging versus CT-derived FFR.…”

Section: Ct Coronary Angiography and Functional Assessmentmentioning

confidence: 99%

“…In addition, 92.9% of individuals in which medical therapy was recommended remained free from revascularisation or major adverse cardiac events at 1 year. 40 As the CT-derived FFR technology is refined over the coming years, it is expected to become increasingly available across the National Health 32,35 As with all non-invasive cardiac imaging, patient selection will be paramount in delivering this service. In addition, centres will require robust systems for optimising CTCA data set acquisition to ensure quality images for CT-derived FFR analysis.…”

Section: Ct Coronary Angiography and Functional Assessmentmentioning

confidence: 99%

Latest Advances in Cardiac CT

et al. 2020

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Recent rapid technological advancements in cardiac CT have improved image quality and reduced radiation exposure to patients. Furthermore, key insights from large cohort trials have helped delineate cardiovascular disease risk as a function of overall coronary plaque burden and the morphological appearance of individual plaques. The advent of CT-derived fractional flow reserve promises to establish an anatomical and functional test within one modality. Recent data examining the short-term impact of CT-derived fractional flow reserve on downstream care and clinical outcomes have been published. In addition, machine learning is a concept that is being increasingly applied to diagnostic medicine. Over the coming decade, machine learning will begin to be integrated into cardiac CT, and will potentially make a tangible difference to how this modality evolves. The authors have performed an extensive literature review and comprehensive analysis of the recent advances in cardiac CT. They review how recent advances currently impact on clinical care and potential future directions for this imaging modality.

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Diagnostic accuracy and discrimination of ischemia by fractional flow reserve CT using a clinical use rule: Results from the Determination of Fractional Flow Reserve by Anatomic Computed Tomographic Angiography study

Abstract: Fractional flow reserveComputational fluid dynamics a b s t r a c t Background: Fractional flow reserve (FFR) is the gold standard for determining lesion-

Cited by 21 publications

References 38 publications

Simplified Models of Non-Invasive Fractional Flow Reserve Based on CT Images

Simplified Models of Non-Invasive Fractional Flow Reserve Based on CT Images

The transluminal attenuation gradient in coronary CT angiography for the detection of hemodynamically significant disease: can all arteries be treated equally?

Latest Advances in Cardiac CT

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