Coronary CT angiography-derived fractional flow reserve correlated with invasive fractional flow reserve measurements – initial experience with a novel physician-driven algorithm
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The present study aimed to determine the feasibility of a novel fractional flow reserve (FFR) algorithm based on coronary CT angiography (cCTA) that permits point-of-care assessment, without data transfer to core laboratories, for the evaluation of potentially ischemia-causing stenoses.
To obtain CT-based FFR, anatomical coronary information and ventricular mass extracted from cCTA datasets were integrated with haemodynamic parameters. CT-based FFR was assessed for 36 coronary artery stenoses in 28 patients in a blinded fashion and compared to catheter-based FFR. Haemodynamically relevant stenoses were defined by an invasive FFR ≤0.80. Time was measured for the processing of each cCTA dataset and CT-based FFR computation. Assessment of cCTA image quality was performed using a 5-point scale.
Mean total time for CT-based FFR determination was 51.9 ± 9.0 min. Per-vessel analysis for the identification of lesion-specific myocardial ischemia demonstrated good correlation (Pearson’s product-moment r = 0.74, p < 0.0001) between the prototype CT-based FFR algorithm and invasive FFR. Subjective image quality analysis resulted in a median score of 4 (interquartile ranges, 3-4).
Our initial data suggest that the CT-based FFR method for the detection of haemodynamically significant stenoses evaluated in the selected population correlates well with invasive FFR and renders time-efficient point-of-care assessment possible.
• CT-based FFR computation is a promising novel non-invasive application.
• A novel prototype algorithm permits time-efficient point-of-care CT-based FFR assessment.
• Initial results of the CT-based FFR prototype algorithm compare favourably with FFR.
KeywordsCoronary artery disease Coronary CT angiography Fractional flow reserve Invasive coronary angiography Myocardial ischemia
Coronary artery disease
Coronary computed tomographic angiography
Fractional flow reserve
- CT-based FFR
Fractional flow reserve from coronary computed tomographic angiography
Invasive coronary catheter angiography
The scientific guarantor of this publication is U. Joseph Schoepf. The authors of this manuscript declare relationships with the following companies: GE, Bracco, Siemens, Bayer and St. Jude. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No animals were used in this study. No study subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution. Fast flow computations of coronary blood flow were not carried out in the United States.
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