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Correlation of FFR-derived from CT and stress perfusion CMR with invasive FFR in intermediate-grade coronary artery stenosis

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Abstract

Only one-third of intermediate-grade coronary artery stenosis (i.e. 40–70% diameter narrowing) causes myocardial ischemia, requiring most often additional invasive work-up with invasive fractional flow reserve (FFR). To evaluate the correlations between FFR estimates derived from computed tomography (FFRCT) and adenosine perfusion cardiac magnetic resonance (CMR) with invasive FFR in intermediate-grade stenosis. Thirty-seven patients (mean age 61 ± 9 years; 25 men) who underwent adenosine perfusion CMR, quantitative coronary angiography and FFR in the work-up for intermediate-grade stenoses (n = 39) diagnosed at coronary CT angiography were retrospectively evaluated. Blinded FFRCT analysis was computed on each intermediate-grade lesion and correlated to the FFR values. On adenosine CMR, subendocardial time-enhancement maximal upslopes, normalized by respective left ventricle cavity upslopes, were obtained distal to a coronary stenosis (RISK area) and in remote myocardium (REMOTE area). The perfusion was subsequently assessed without (uncorrected RISK) and after correction for remote perfusion (relative myocardial perfusion index = REMOTE/RISK ratio), and then correlated to the FFR values. Differences in correlations were tested with z statistics and considered statistically significant different at a p < 0.05 level. The average FFR value was 0.85 ± 0.10 (0.60–0.98 range), 28% (n = 11) was ≤ 0.80. FFR value correlated poorly with uncorrected RISK upslopes (r = 0.151; p = 0.36), but equally strongly with FFRCT (r = 0.675; p < 0.001) and the relative myocardial perfusion index (r = − 0.63) (p < 0.001; z = 6.72) for assessment of lesion-specific ischemia. Both FFRCT and adenosine perfusion CMR strongly correlate with invasive FFR measurements for intermediate-grade stenosis. These preliminary findings pave the way for further studies evaluating non-invasively intermediate coronary stenosis in clinical practice.

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Abbreviations

FFR:

Fractional flow reserve

FFRCT :

FFR estimates derived from computed tomography

CMR:

Cardiac magnetic resonance

CTA:

Computed tomography angiography

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Acknowledgements

The authors are grateful to Bracco imaging and General Electrics Healthcare for the study support.

Funding

This study has received funding by General Electrics Healthcare. The funding has been used to cover the costs of the adenosine perfusion MR, the contrast medium and adenosine of all included patients. Funding for the FFRCT analysis was received by Bracco imaging.

Author information

Authors and Affiliations

  1. Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye, 75, 4000, Liège, Belgium

    Olivier Ghekiere & Isabelle Mancini

  2. Department of Radiology, Jessa Ziekenhuis, Stadsomvaart 11, 3500, Hasselt, Belgium

    Olivier Ghekiere & Jurgen Bielen

  3. Faculty of Medicine and Life Sciences, Biomed and Reval, Hasselt University, Agoralaan, Building A and C, 3500, Hasselt, Belgium

    Olivier Ghekiere, Dominic Hansen & Paul Dendale

  4. Department of Radiology, St Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, BCV6Z 1Y6, Canada

    Jonathon Leipsic

  5. Department of Cardiology, Imelda Hospital, Imeldalaan 9, 2820, Bonheiden, Belgium

    Willem Dewilde

  6. Heart Center Hasselt, Jessa Ziekenhuis, Stadsomvaart 11, 3500, Hasselt, Belgium

    Paul Dendale

  7. Centre Hospitalier de Luxembourg, 4, Rue Ernest Barble L-1120, LU 1210, Luxembourg City, Luxembourg

    Alain Nchimi

Authors
  1. Olivier Ghekiere
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  2. Jurgen Bielen
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  3. Jonathon Leipsic
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  4. Willem Dewilde
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  5. Isabelle Mancini
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  6. Dominic Hansen
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  7. Paul Dendale
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  8. Alain Nchimi
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Corresponding author

Correspondence to Olivier Ghekiere.

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Conflict of interest

Jonathon Leipsic: Grant/Research Support: Edwards Lifesciences, Neovasc, Tendyne, HeartFlow, Samsung; Consultant: Circle CVI, Edwards, HeartFlow, Samsung; Stock Options: Arineta, Pi Cardia. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Ethical approval

Institutional Review Board approval was obtained.

Statistics

One of the authors, Dominique Hansen, has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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Ghekiere, O., Bielen, J., Leipsic, J. et al. Correlation of FFR-derived from CT and stress perfusion CMR with invasive FFR in intermediate-grade coronary artery stenosis. Int J Cardiovasc Imaging 35, 559–568 (2019). https://doi.org/10.1007/s10554-018-1464-4

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  • DOI: https://doi.org/10.1007/s10554-018-1464-4

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