Diagnostic Performance of Noninvasive Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography in Suspected Coronary Artery Disease

Nørgaard, Bjarne Linde; Leipsic, Jonathon; Gaur, Sara; Seneviratne, Sujith; Ko, Brian; Ito, Hiroshi; Jensen, Jesper Møller; Mauri, Laura; Bruyne, Bernard De; Bezerra, Hiram G.; Osawa, Kazuhiro; Marwan, Mohamed; Naber, Christoph; Ērglis, Andrejs; Park, Seung‐Jung; Christiansen, Evald Høj; Kaltoft, Anne; Lassen, Jens Flensted; Bøtker, Hans Erik; Achenbach, Stephan

doi:10.1016/j.jacc.2013.11.043

Cited by 1,228 publications

(662 citation statements)

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“…Although the presentation is usually silent, clinical manifestations may include aborted sudden death, chest pain, arrhythmia, and/or exercise‐induced presyncope or syncope. The FFR CT , derived from the usual data set from coronary CT angiography, was recently developed to evaluate functional ischemia of the coronary artery 1. In the present case, FFR CT revealed ischemia in an anomalous coronary artery, which was confirmed by the invasive FFR measurement.…”

Section: Case Reportsupporting

confidence: 64%

Anomalous aortic origin of the right coronary artery with functional ischemia determined with fractional flow reserve derived from computed tomography

Miki

Miyoshi

Watanabe

et al. 2018

Clinical Case Reports

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Section: Case Reportsupporting

confidence: 64%

Anomalous aortic origin of the right coronary artery with functional ischemia determined with fractional flow reserve derived from computed tomography

Miki

Miyoshi

Watanabe

et al. 2018

Clinical Case Reports

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“…To further expand the use of physiological‐guided percutaneous coronary intervention, coronary computed tomography angiography– and invasive coronary angiography–based computation methods were developed for less‐invasive FFR approximation 4, 5, 6, 7, 8, 9, 10…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of In‐Procedure Angiography‐Derived Quantitative Flow Reserve Compared to Pressure‐Derived Fractional Flow Reserve: The FAVOR II Europe‐Japan Study

Westra

Andersen

Campo

et al. 2018

JAHA

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BackgroundQuantitative flow ratio (QFR) is a novel modality for physiological lesion assessment based on 3‐dimensional vessel reconstructions and contrast flow velocity estimates. We evaluated the value of online QFR during routine invasive coronary angiography for procedural feasibility, diagnostic performance, and agreement with pressure‐wire–derived fractional flow reserve (FFR) as a gold standard in an international multicenter study.Methods and Results FAVOR II E‐J (Functional Assessment by Various Flow Reconstructions II Europe‐Japan) was a prospective, observational, investigator‐initiated study. Patients with stable angina pectoris were enrolled in 11 international centers. FFR and online QFR computation were performed in all eligible lesions. An independent core lab performed 2‐dimensional quantitative coronary angiography (2D‐QCA) analysis of all lesions assessed with QFR and FFR. The primary comparison was sensitivity and specificity of QFR compared with 2D‐QCA using FFR as a reference standard. A total of 329 patients were enrolled. Paired assessment of FFR, QFR, and 2D‐QCA was available for 317 lesions. Mean FFR, QFR, and percent diameter stenosis were 0.83±0.09, 0.82±10, and 45±10%, respectively. FFR was ≤0.80 in 104 (33%) lesions. Sensitivity and specificity by QFR was significantly higher than by 2D‐QCA (sensitivity, 86.5% (78.4–92.4) versus 44.2% (34.5–54.3); P<0.001; specificity, 86.9% (81.6–91.1) versus 76.5% (70.3–82.0); P=0.002). Area under the receiver curve was significantly higher for QFR compared with 2D‐QCA (area under the receiver curve, 0.92 [0.89–0.96] versus 0.64 [0.57–0.70]; P<0.001). Median time to QFR was significantly lower than median time to FFR (time to QFR, 5.0 minutes [interquartile range, –6.1] versus time to FFR, 7.0 minutes [interquartile range, 5.0–10.0]; P<0.001).ConclusionsOnline computation of QFR in the catheterization laboratory is clinically feasible and is superior to angiographic assessment for evaluation of intermediary coronary artery stenosis using FFR as a reference standard.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02959814.

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“…Based on these techniques, noninvasive fractional flow reserve (FFR) can be computed 3, 4, 5, 6. In studies including patients with known or suspected stable CAD and blinded comparison to FFR, coronary CTA‐derived FFR (FFR CT ) has shown high diagnostic performance 4, 5, 6. Recently, it was demonstrated in stable patients referred to ICA that initial FFR CT assessment reduced the downstream use of ICA procedures, the rate of ICA showing no obstructive CAD, and overall costs 7.…”

Section: Introductionmentioning

confidence: 99%

Myocardial Perfusion Imaging Versus Computed Tomography Angiography–Derived Fractional Flow Reserve Testing in Stable Patients With Intermediate‐Range Coronary Lesions: Influence on Downstream Diagnostic Workflows and Invasive Angiography Findings

Nørgaard

Gormsen

Bøtker

et al. 2017

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BackgroundData on the clinical utility of coronary computed tomography angiography–derived fractional flow reserve (FFRCT) are sparse. In patients with intermediate (40–70%) coronary stenosis determined by coronary computed tomography angiography, we investigated the association of replacing standard myocardial perfusion imaging with FFRCT testing with downstream utilization of invasive coronary angiography (ICA) and the diagnostic yield of ICA (rate of no obstructive disease, and rate of revascularization).Methods and ResultsThis was a single‐center observational study of symptomatic patients with suspected coronary artery disease referred to coronary computed tomography angiography between 2013 and 2015. Patients were divided into 3 historical groups based on the adjunctive functional testing approach: myocardial perfusion imaging (n=1332) or FFRCT “implementation” (n=800) or “clinical use” (n=1391). Propensity score matching was used to estimate the average period effect on outcomes. Patients in the FFRCT clinical use group versus the myocardial perfusion imaging group were older and had higher pretest probability of obstructive disease. After adjusting for baseline risk characteristics, there was a reduction in downstream ICA utilization (absolute risk difference: −4.2; 95% CI, −6.9 to −1.6; P=0.002). In patients referred to ICA, findings of no obstructive coronary artery disease decreased (−12.8%; 95% CI, −22.2 to −3.4; P=0.008) and rate of coronary revascularization increased (14.1%; 95% CI, 3.3–24.9; P=0.01), as did availability of functional information for guidance of revascularization (27.8%; 95% CI, 11.3–44.4; P<0.001) after clinical adoption of FFRCT.ConclusionsReplacing adjunctive myocardial perfusion imaging with FFRCT testing for functional assessment of intermediate stenosis determined by coronary computed tomography angiography in stable coronary artery disease was associated with less ICA utilization, and a higher ICA diagnostic yield. The findings in this observational study needs confirmation in prospective, randomized trials.

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Diagnostic Performance of Noninvasive Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography in Suspected Coronary Artery Disease

Cited by 1,228 publications

References 27 publications

Anomalous aortic origin of the right coronary artery with functional ischemia determined with fractional flow reserve derived from computed tomography

Anomalous aortic origin of the right coronary artery with functional ischemia determined with fractional flow reserve derived from computed tomography

Diagnostic Performance of In‐Procedure Angiography‐Derived Quantitative Flow Reserve Compared to Pressure‐Derived Fractional Flow Reserve: The FAVOR II Europe‐Japan Study

Myocardial Perfusion Imaging Versus Computed Tomography Angiography–Derived Fractional Flow Reserve Testing in Stable Patients With Intermediate‐Range Coronary Lesions: Influence on Downstream Diagnostic Workflows and Invasive Angiography Findings

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