Optimized interpretation of fractional flow reserve derived from computed tomography: Comparison of three interpretation methods

Takagi, Hidenobu; Ishikawa, Yu; Orii, Makoto; Ota, Hideki; Niiyama, Masanobu; Tanaka, Ryoichi; Morino, Yoshihiro; Yoshioka, Kunihiro

doi:10.1016/j.jcct.2018.10.027

Cited by 26 publications

(21 citation statements)

References 23 publications

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“…10 Third, revascularization was not guided by invasive FFR. However, the cut-off value derived from the early revascularization as a clinical endpoint was similar to one which compared invasive FFR 0.80 or not in previous study, 16 which may support that the decision for early revascularization was based on coronary physiology in the ADVANCE registry. Finally, the ICA referral simulation did not take into account symptoms and risk factors.…”

Section: Discussionsupporting

confidence: 75%

“…1). 16 The distance between the proximal and distal ΔFFR CT reference points was visually assessed to characterize the stenosis type (Fig. 1D-F In a case with diffuse stenosis, after placing proximal reference at the most adjacent to the visible stenosis, carefully looked along downstream coronary and placed the distal reference at the point with visually normal diameter being the most adjacent to stenosis.…”

Section: Ffr Ct Analysis and Measurementsmentioning

confidence: 99%

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Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registry

Takagi

Leipsic

McNamara

et al. 2022

Journal of Cardiovascular Computed Tomography

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Background: The role of change in fractional flow reserve derived from CT (FFR CT ) across coronary stenoses (ΔFFR CT ) in guiding downstream testing in patients with stable coronary artery disease (CAD) is unknown. Objectives: To investigate the incremental value of ΔFFR CT in predicting early revascularization and improving efficiency of catheter laboratory utilization. Materials: Patients with CAD on coronary CT angiography (CCTA) were enrolled in an international multicenter registry. Stenosis severity was assessed as per CAD-Reporting and Data System (CAD-RADS), and lesion-specific FFR CT was measured 2 cm distal to stenosis. ΔFFR CT was manually measured as the difference of FFR CT across visible stenosis.

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Section: Discussionsupporting

confidence: 75%

Section: Ffr Ct Analysis and Measurementsmentioning

confidence: 99%

Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registry

Takagi

Leipsic

McNamara

et al. 2022

Journal of Cardiovascular Computed Tomography

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“…At present, FFR CT is a reasonable option for informing downstream ICA and treatment planning in patients with moderate to severe single and multivessel disease (30e90% severity) with a limited role in patients with 50% left main stenosis or critical triple vessel disease. 101,102 Other approaches reporting similar results, e.g., machine learning without utilizing computational fluid dynamics, 103 have been reported but have not yet received approval. On site techniques might improve adoption of CT-FFR more widely but these are still under development for routine clinical use.…”

Section: Plaque Characterizationmentioning

confidence: 99%

SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography

Narula

Chandrashekhar

Ahmadi

et al. 2021

Journal of Cardiovascular Computed Tomography

192

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2.1.2. Diagnostic performance of functional imaging and CTA compared to >50% diameter stenosis by ICA The National Cardiovascular Data Registry 9 suggested that functional testing is suboptimal for detecting significant coronary stenoses. Of the 661,063 patients undergoing elective catheterization, 64% had testing before the invasive coronary angiogram (ICA); of those, only 51.9% were abnormal. The percentages of patients with <50% DS on subsequent ICA ranged from 55 to 56% after an abnormal exercise treadmill test (ETT), stress echocardiography (SE), single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI); for resting CTA, the percentage was 30%. In the oldest report, Fleischmann et al. evaluated 5874 patients in 41 studies from 1990 to 1997, and reported sensitivity and specificity of 85% and 77% for SE and 87% and 64% for SPECT, with 52% and 71% for exercise ECG. 10 DeJong et al. (Table 2A), in a meta-analysis of 5088 patients in 51 studies from 2000 to 2011 evaluated MRI, SE and SPECT with >50%DS by ICA as reference. 11 MRI was the most sensitive and specific (91% and 80%), with SE (87% and 72%) and SPECT (83% and 77%) roughly similar. Jaarsma et al. (Table 2B), reported on SPECT, MRI and positron emission tomography (PET) in 141 per-patient studies and 70 per-vessel studies. 12 Per-patient diagnostic odds ratio (DOR) was highest for PET (36.47) followed by MRI (26.42) and SPECT (16.31). In pervessel analysis, PET and MRI were equal (24.74 and 24.11), while SPECT was lowest (11.75). In a meta-analysis limited to 26 studies in which CTA was compared to either ETT or SPECT in the same group of patients, Nielsen et al. 13 (Table 2C) reported CTA sensitivities of 95e99%, specificities of 68e93% and DOR of 128e728. Corresponding ranges for ETT were 65e70%, 24e60% and 0.7e4 and for SPECT were 67e73%, 48e52% and 2e4. It is important to understand that available meta-analyses are also challenged by the small numbers of patients in some of the individual reports, potential referral bias, and often include a mixture of newer and older technology (e.g., planar and SPECT imaging). Finally, in a paper published too recently for meta-analysis inclusion, 391 symptomatic patients, 52% with intermediate and 46% with high risk pre-test probability, who were scheduled for ICA, underwent both CTA and SPECT with >50%DS by ICA as reference. 14 Sensitivity, specificity, positive and negative predictive values were 0.92, 0.75, 0.84 and 0.87 for CTA and 0.62, 0.68, 0.74 and 0.55 for SPECT. AUC was significantly higher for CTA (0.91 versus 0.69, p < 0.001.

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“…Distal Vessel FFR CT Values FFR CT provides simultaneous computation of pressure and flow in the entire coronary tree, thus exposing both lesion-specific pressure as well as nadir FFR CT values across the coronary system, which in various settings may drop less than or equal to 0.80 (14,19,(34)(35)(36) (Fig 1). Low terminal vessel FFR CT values (rather than a value distal to stenosis) may include effects unrelated to the stenosis (19,(35)(36)(37).…”

Section: Nørgaard Et Almentioning

confidence: 99%

“…In patients with CAD, as for measured FFR, FFR CT values decline from the ostium to the distal vessel irrespective of the vessel territory, stenosis severity, and location (14,19,(34)(35)(36). In FFR practice, it is advised that the FFR value within the throat of the lesion (which may correspond to the minimum FFR CT value) is not used clinically and that the pressure is assessed at least 2-3 cm distal to the stenosis of interest (20).…”

Section: Standardized Interpretation Of Hemodynamically Significant Lmentioning

confidence: 99%

Coronary CT Angiography-derived Fractional Flow Reserve Testing in Patients with Stable Coronary Artery Disease: Recommendations on Interpretation and Reporting

Nørgaard¹,

Fairbairn²,

Safian³

et al. 2019

Radiology: Cardiothoracic Imaging

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Noninvasive fractional flow reserve derived from coronary CT angiography (FFR CT ) is increasingly used in patients with coronary artery disease as a gatekeeper to the catheterization laboratory. While there is emerging evidence of the clinical benefit of FFR CT in patients with moderate coronary disease as determined with coronary CT angiography, there has been less focus on interpretation, reporting, and integration of FFR CT results into routine clinical practice. Because FFR CT analysis provides a plethora of information regarding pressure and flow across the entire coronary tree, standardized criteria on interpretation and reporting of the FFR CT analysis result are of crucial importance both in context of the clinical adoption and in future research. This report represents expert opinion and recommendation on a standardized FFR CT interpretation and reporting approach.Published under a CC BY 4.0 license.

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Optimized interpretation of fractional flow reserve derived from computed tomography: Comparison of three interpretation methods

Cited by 26 publications

References 23 publications

Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registry

Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registry

SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography

Coronary CT Angiography-derived Fractional Flow Reserve Testing in Patients with Stable Coronary Artery Disease: Recommendations on Interpretation and Reporting

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