Evaluation of fractional flow reserve in patients with stable angina: can CT compete with angiography?

  • Xin Liu
  • Yabin Wang
  • Heye Zhang
  • Youbing Yin
  • Kunlin Cao
  • Zhifan Gao
  • Huafeng Liu
  • William Kongto Hau
  • Lei Gao
  • Yundai Chen
  • Feng CaoEmail author
  • Wenhua HuangEmail author



We aimed to compare the performance of FFRCT and FFRQCA in assessing the functional significance of coronary artery stenosis in patients suffering from coronary artery disease with stable angina.


A total of 101 stable coronary heart disease (CAD) patients with 181 lesions were recruited. FFRCT and FFRQCA were compared using invasive fractional flow reserve (FFR) as a reference standard. Comparisons between FFRCT and FFRQCA were conducted based on strategies of the geometric reconstruction, boundary conditions, and geometric characteristics. The performance of FFRCT and FFRQCA in detecting hemodynamic significance was also investigated.


The performance of FFRCT and FFRQCA in discriminating hemodynamically significant lesions was compared. Good correlation and agreement with invasive FFR was found using FFRCT and FFRQCA (r = 0.809, p < 0.001 and r = 0.755, p < 0.001). A significant difference was observed in the complex coronary artery tree, in which relatively better prediction was observed using FFRCT than FFRQCA when analyzing the stenosis distributed in the middle segment of a stenotic branch (p = 0.036). Moreover, FFRCT was found to be better at predicting hemodynamically insignificant stenosis than FFRQCA (p = 0.007), while the performance of the two parameters was similar in discriminating functional significant lesions using an FFR threshold of ≤ 0.8 as a reference standard.


FFRCT and FFRQCA could both accurately rule out functional insignificant lesions in stable CAD patients. FFRCT was found to be better for the noninvasive screening of CAD patients with stable angina than FFRQCA.

Key Points

• FFR CT and FFR QCA were both in good correlation and agreement with invasive FFR measurements.

• FFR CT is superior in accuracy and consistency compared to FFR QCA in patients with stenoses distributed in left coronary artery.

• The noninvasive nature of FFR CT could provide potential benefit for stable CAD patients on disease management.


Myocardial fractional flow reserve Computed tomography angiography Coronary artery disease Hemodynamics Myocardial ischemia 



Analysis of variance


Area under the receiver operating characteristic curve


Bifurcation number


Coronary artery disease


Coronary CT angiography


Diagonal artery


The fractional flow reserve versus angiography for guiding PCI in patients with multivessel coronary artery disease


Fractional flow reserve


Computed tomography–derived FFR


Quantitative coronary angiography-derived FFR


Gray zone


Ischemia confirmed


Invasive coronary angiography


Left anterior descending branches


Left coronary artery


Left circumflex branches


Stenosis distribution in LCA and RCA


Negative predictive value


Obtuse marginal artery


Percutaneous coronary intervention


Positive predictive value


Quantitative coronary angiography


Right coronary artery


Stratification according to FFR


Standard deviation


Number of lesions in a single branch



This work was supported by grants from Shenzhen–Hong Kong Innovation Circle Program (SGLH20161212104605195), National Key Research and Development Program of China (2016YFC1300300, 2017YFC1103403, 2016YFA0100900), Shenzhen Science and Technology Program (JCYJ20170413114916687, JCYJ20170306092258717), National Natural Science Foundation of China (61771464, U1801265, 81500360, 81227901, 81530058, and 81570272), the Science and Technology Project of Guangdong Province (2016B090925001, 2017B090912006), and China Postdoctoral Science Foundation (2016T90990 and 2016M603026).

Compliance with ethical standards


The scientific guarantor of this publication is Feng Cao.

Conflict of interest

The authors report no relationships that could be construed as a conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained.

Ethical approval

Institutional Review Board approved the present study.


• retrospective

• observational

• performed at one institution

Supplementary material

330_2019_6023_MOESM1_ESM.docx (579 kb)
ESM 1 (DOCX 578 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Xin Liu
    • 1
    • 2
  • Yabin Wang
    • 3
  • Heye Zhang
    • 4
  • Youbing Yin
    • 5
  • Kunlin Cao
    • 5
  • Zhifan Gao
    • 6
  • Huafeng Liu
    • 7
  • William Kongto Hau
    • 8
  • Lei Gao
    • 3
  • Yundai Chen
    • 3
  • Feng Cao
    • 3
    Email author
  • Wenhua Huang
    • 9
    Email author
  1. 1.Shenzhen Institutes of Advanced Technology & National Clinical Research Center of Geriatric DiseaseChinese PLA General HospitalBeijingChina
  2. 2.Guangdong Academy Research on VR IndustryFoshan UniversityFoshanChina
  3. 3.Department of Cardiology & National Clinical Research Center of Geriatric DiseaseChinese PLA General HospitalBeijingChina
  4. 4.Shenzhen Institutes of Advanced TechnologyChinese Academy of SciencesShenzhenChina
  5. 5.Shenzhen Keya Medical TechnologyShenzhenChina
  6. 6.The School of Schulich Medicine and DentistryWestern UniversityLondonCanada
  7. 7.State Key Laboratory of Modern Optical InstrumentationZhejiang UniversityHangzhouChina
  8. 8.Department of Medicine and Therapeutics, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
  9. 9.School of Basic Medical Science, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical BiomechanicsSouthern Medical UniversityGuangzhouChina

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