Fractional Flow Reserve Computed from Noninvasive CT Angiography Data: Diagnostic Performance of an On-Site Clinician-operated Computational Fluid Dynamics Algorithm

Abstract

With use of a reduced-order algorithm, computation of the FFR from coronary CT angiography data can be performed locally, at a regular workstation. The diagnostic accuracy of coronary CT angiography-derived computational FFR for the detection of functionally important coronary artery disease (CAD) was good and was incremental to that of coronary CT angiography within a population with a high prevalence of CAD.

On the use of computed tomography in cardiac imaging

“…Although a small study, these results are in the same range as the results obtained by other authors using the same software (104,105), and they are also similar to those obtained in the DeFACTO and NXT studies (110,111), where similar software from another vendor was used. Maybe most importantly, the high negative predictive value of 0.93-0.94 (depending on the cut-off limit for significant stenosis) suggests that cFFR has the potential to be very useful in the triage to invasive angiography, possibly reducing the need for further invasive investigation in a number of patients.…”

“…The average time of approximately 45 minutes required for the cFFR analysis was also in line with the results recorded by Coenen et al (105). Although the comparatively short processing time in itself facilitates an efficient patient flow compared to other current solutions, newer algorithms and even faster hardware are expected to make the processing close to instantaneous in the near future.…”

Feasibility of Stress-Alone Cardiac CT for Detecting Hemodynamically Significant Coronary Stenosis in the Presence of High Coronary Calcium Score and Coronary Stents

“…With FFR-CT, the hemodynamic significance of coronary artery stenosis can be assessed from rest CTA without performing stress CTP. Currently, several vendors provide on-site FFR-CT applications, which may increase the applicability of the technology in clinical and research settings [17,18]. However, computation of FFR-CT is dependent on CTA image quality [19], and further studies may be required, especially in the presence of heavily calcified plaques and prior stents.…”

Letter by Baumann et al Regarding Article, “Fractional Flow Reserve and Coronary Computed Tomographic Angiography: A Review and Critical Analysis”

“…2,3 We would like to complete the references of the excellent review by adding a few important landmark and other studies using the fast on-site CT-FFR algorithm. The retrospective, singlecenter study by Coenen et al 4 included 189 vessels of 106 patients and showed an improvement of the specificity from 37.6% (95% confidence interval, 28.5%-47.4%) for coronary computed tomography angiography alone compared with 65.1% (95% confidence interval, 55.4%-74.0%) by CT-FFR. Similar results were presented in a smaller Swedish study with 21 patients, demonstrating CT-FFR a specificity of 76% per lesion 80% per patient.…”