Fractional flow reserve as the standard of reference: All that glistens is not gold

Benz, Dominik C.; Giannopoulos, Andreas A.

doi:10.1007/s12350-019-01771-3

Cited by 5 publications

(6 citation statements)

References 30 publications

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“…As a result, the estimated coronary morphologic index [eg., lesion length/minimal lesion diameter ( 29 )] from our study is significant greater (12.3 vs. 4.8, p < 0.0001) in the group with FFR ≤ 0.8 vs. the group with FFR >0.8, which is in agreement with the findings from the study of Li ( 29 ). In addition to the aforementioned coronary morphologic index, other lesion geometric parameters, like flow entry and exit angles to lesions, have been associated with fluid convective and diffusive energy loss and pressure drop ( 3 , 4 ). We have incorporated these additional elements in formulating the expressions for FFR AM calculation.…”

Section: Discussionmentioning

confidence: 99%

“…Fractional flow reserve (FFR), measured during invasive coronary angiography (ICA), is the reference standard for quantifying the functional significance of coronary artery stenoses and discriminating ischemic lesions ( 2 , 3 ). However, ICA-based FFR measurement incurs additional resource utilization, increases procedural time, and is associated with greater patient discomfort ( 4 ). Recently, non-invasive FFR (FFR CT ) derived from computed tomography coronary angiography (CTCA) images and computational fluid dynamics (CFD) has demonstrated feasibility for the identification of ischemic coronary lesions ( 5 ) with reasonable diagnostic accuracy ( 6 ) and prognostication ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Performance of Fractional Flow Reserve From CT Coronary Angiography With Analytical Method

Zhang

Han

Tan

et al. 2021

Front. Cardiovasc. Med.

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The aim of this study was to evaluate a new analytical method for calculating non-invasive fractional flow reserve (FFRAM) to diagnose ischemic coronary lesions. Patients with suspected or known coronary artery disease (CAD) who underwent computed tomography coronary angiography (CTCA) and invasive coronary angiography (ICA) with FFR measurements from two sites were prospectively recruited. Obstructive CAD was defined as diameter stenosis (DS) ≥50% on CTCA or ICA. FFRAM was derived from CTCA images and anatomical features using analytical method and was compared with computational fluid dynamics (CFD)-based FFR (FFRB) and invasive ICA-based FFR. FFRAM, FFRB, and invasive FFR ≤ 0.80 defined ischemia. A total of 108 participants (mean age 60, range: 30–83 years, 75% men) with 169 stenosed coronary arteries were analyzed. The per-vessel accuracy, sensitivity, specificity, and positive predictive and negative predictive values were, respectively, 81, 75, 86, 81, and 82% for FFRAM and 87, 88, 86, 83, and 90% for FFRB. The area under the receiver operating characteristics curve for FFRAM (0.89 and 0.87) and FFRB (0.90 and 0.86) were higher than both CTCA- and ICA-derived DS (all p < 0.0001) on per-vessel and per-patient bases for discriminating ischemic lesions. The computational time for FFRAM was much shorter than FFRB (2.2 ± 0.9 min vs. 48 ± 36 min, excluding image acquisition and segmentation). FFRAM calculated from a novel and expeditious non-CFD approach possesses a comparable diagnostic performance to CFD-derived FFRB, with a significantly shorter computational time.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of Fractional Flow Reserve From CT Coronary Angiography With Analytical Method

Zhang

Han

Tan

et al. 2021

Front. Cardiovasc. Med.

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Section: Coronary Artery Disease and Atherosclerosismentioning

confidence: 99%

“…While the mechanism for such high false-positive rate particularly in the LAD remains unclear, FFR should still be interpreted in the context of MPI and individualized to each patient. 24 Multivessel CAD is often challenging to detect on MPI where perfusion defects sometimes underestimate the extent of disease. Transient ischemic dilatation, stress-induced decrease in LV ejection fraction, abnormal MBF, among other variables provide additional and complementary prognostic data to traditional perfusion imaging.…”

Section: Coronary Artery Disease and Atherosclerosismentioning

confidence: 99%

Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2020: positron emission tomography, computed tomography, and magnetic resonance

AlJaroudi

Hage

2021

Journal of Nuclear Cardiology

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Although the year 2020 was different from other years in many respects, the Journal of Nuclear Cardiology published excellent articles pertaining to imaging in patients with cardiovascular disease due to the dedication of the investigators in our field all over the world. In this review, we will summarize a selection of these articles to provide a concise review of the main advancements that have recently occurred in the field and provide the reader with an opportunity to review a wide selection of articles. We will focus on publications dealing with positron emission tomography, computed tomography, and magnetic resonance and hope that you will find this review helpful.

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“…Many studies have shown that by implementing a strategy of FFR-guided percutaneous coronary intervention, the number of implanted stents is reduced, and clinical outcomes are significantly improved ( 7 – 10 ). However, there are many challenges with FFR measurement, such as wire cost, limitations associated with induction of hyperemia, and additional procedure time ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Angiographic Lesion Morphology Provides Incremental Value to Generalize Quantitative Flow Ratio for Predicting Myocardial Ischemia

Zhang

Zhao

et al. 2022

Front. Cardiovasc. Med.

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AimThe quantitative flow ratio (QFR) is favorable for functional assessment of coronary artery stenosis without pressure wires and induction of hyperemia. The aim of this study was to explore whether angiographic lesion morphology provides incremental value to generalize QFR for predicting myocardial ischemia in unselected patients.MethodsThis study was a substudy to the CT-FFR CHINA trial, referring 345 participants from five centers with suspected coronary artery disease on coronary CT angiography for diagnostic invasive coronary angiography (ICA). Fractional flow reserve (FFR) was measured in all vessels with 30–90% diameter stenosis. QFR was calculated in 186 lesions from 159 participants in a blinded manner. In addition, parameters to characterize lesion features were recorded or measured, including left anterior descending arteries (LADs)-involved lesions, side branch located at stenotic lesion (BL), multiple lesions (ML), minimal lumen diameter (MLD), reference lumen diameter (RLD), percent diameter stenosis (%DS), lesion length (LL), and LL/MLD4. Logistic regression was used to construct two kinds of models by combining single or two lesion parameters with the QFR. The performances of these models were compared with that of QFR on a per-vessel level.ResultsA total of 148 participants (mean age: 59.5 years; 101 men) with 175 coronary arteries were included for final analysis. In total, 81 (46%) vessels were considered hemodynamically significant. QFR correctly classified 82.29% of the vessels using FFR with a cutoff of 0.80 as reference standard. The area under the receiver operating characteristic curve (AUC) of QFR was 0.86 with a sensitivity, specificity, positive predictive value, and negative predictive value of 80.25, 84.04, 81.25, and 83.16%, respectively. The combined models (QFR + LAD + MLD, QFR + LAD + %DS, QFR + BL + MLD, and QFR + BL + %DS) outperformed QFR with higher AUCs (0.91 vs. 0.86, P = 0.02; 0.91 vs. 0.86, P = 0.02; 0.91 vs. 0.86, P = 0.02; 0.90 vs. 0.86, P = 0.03, respectively). Compared with QFR, the sensitivity of the combined models (QFR + BL and QFR + MLD) was improved (91.36 vs. 80.25%, 91.36 vs. 80.25%, respectively, both P < 0.05) without compromised specificity or accuracy.ConclusionCombined with angiographic lesion parameters, QFR can be optimized for predicting myocardial ischemia in unselected patients.

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Fractional flow reserve as the standard of reference: All that glistens is not gold

Cited by 5 publications

References 30 publications

Diagnostic Performance of Fractional Flow Reserve From CT Coronary Angiography With Analytical Method

Diagnostic Performance of Fractional Flow Reserve From CT Coronary Angiography With Analytical Method

Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2020: positron emission tomography, computed tomography, and magnetic resonance

Angiographic Lesion Morphology Provides Incremental Value to Generalize Quantitative Flow Ratio for Predicting Myocardial Ischemia

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