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

Abstract

Background

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.

Method

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.

Results

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.

Conclusion

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.

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Abbreviations

ANOVA:

Analysis of variance

AUC:

Area under the receiver operating characteristic curve

BFN:

Bifurcation number

CAD:

Coronary artery disease

CCTA:

Coronary CT angiography

DB:

Diagonal artery

FAME:

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

FFR:

Fractional flow reserve

FFRCT :

Computed tomography–derived FFR

FFRQCA :

Quantitative coronary angiography-derived FFR

GZ:

Gray zone

IC:

Ischemia confirmed

ICA:

Invasive coronary angiography

LAD:

Left anterior descending branches

LCA:

Left coronary artery

LCX:

Left circumflex branches

LR:

Stenosis distribution in LCA and RCA

NPV:

Negative predictive value

OM:

Obtuse marginal artery

PCI:

Percutaneous coronary intervention

PPV:

Positive predictive value

QCA:

Quantitative coronary angiography

RCA:

Right coronary artery

S:

Stratification according to FFR

SD:

Standard deviation

StO:

Number of lesions in a single branch

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Funding

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).

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Correspondence to Feng Cao or Wenhua Huang.

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Liu, X., Wang, Y., Zhang, H. et al. Evaluation of fractional flow reserve in patients with stable angina: can CT compete with angiography?. Eur Radiol 29, 3669–3677 (2019). https://doi.org/10.1007/s00330-019-06023-z

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Keywords

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