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Comparison Between Non-invasive (Coronary Computed Tomography Angiography Derived) and Invasive-Fractional Flow Reserve in Patients with Serial Stenoses Within One Coronary Artery: A NXT Trial substudy

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Abstract

Fractional flow reserve (FFR) has been established as gold standard to detect hemodynamically significant coronary artery disease. Non-invasive FFR derived from coronary computed tomography angiography (CTA; FFRCT) has demonstrated higher diagnostic performance compared with FFR. However, the accuracy and potential advantages of FFRCT compared with invasive FFR in coronary arteries with serial lesions have not been examined. The aim of this study was to compare trans-lesional gradient in FFRCT to that in invasive FFR in coronary arteries with serial stenoses. Eighteen vessels with serial coronary lesions from 18 stable angina patients were evaluated with angiography, FFR, and coronary CTA. FFRCT was computed from 3-dimensional CT model and coronary flow dynamics data. Multiple FFRCT values were co-registered with measured FFR across the lesions, and trans-lesional delta were compared between FFRCT and FFR. The mean values of the most distal FFR and FFRCT in the same co-registered regions were 0.72 ± 0.10 and 0.69 ± 0.11, respectively. In 13 vessels (72.2%), FFR was ≤0.80, while in 14 vessels (77.8%), FFRCT was ≤0.80. Trans-lesional delta FFR and FFRCT were 0.10 ± 0.09 and 0.09 ± 0.10 in distal segments, while 0.17 ± 0.10 and 0.22 ± 0.13 in proximal segments, respectively. The coefficient of correlation between trans-lesional delta FFR and FFRCT in each segment was 0.92 (p < 0.001). Trans-lesional delta FFR and FFRCT show an excellent correlation. Further studies are required to determine the diagnostic accuracy and clinical impact of our findings.

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Abbreviations

CAD:

Coronary artery disease

CTA:

Computed tomography angiography

FFR:

Fractional flow reserve

FFRCT :

Computed fractional flow reserve

ICA:

Invasive coronary angiography

PCI:

Percutaneous coronary intervention

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Conflict of Interest

Dr. Nørgaard has received research grants from Edwards Lifesciences. None of other authors have any conflicts of interest to declare. Dr. Rogers is an employee of HeartFlow, which provides FFRCT.

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    Authors and Affiliations

    1. Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA

      Kentaro Tanaka, Hiram G. Bezerra, Guilherme F. Attizzani & Marco A. Costa

    2. Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark

      Sara Gaur, Hans Erik Bøtker & Bjarne L. Nørgaard

    3. Department of Interventional Cardiology, Pitangueiras Hospital, Jundiaí, Brazil

      Guilherme F. Attizzani

    4. HeartFlow Inc., Redwood City, CA, USA

      Campbell Rogers

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    1. Kentaro Tanaka
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    Correspondence to Hiram G. Bezerra.

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    Associate Editor Sean McGinty oversaw the review of this article.

    Drs. Tanaka and Bezerra have contributed equally as first authors for this study.

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    Tanaka, K., Bezerra, H.G., Gaur, S. et al. Comparison Between Non-invasive (Coronary Computed Tomography Angiography Derived) and Invasive-Fractional Flow Reserve in Patients with Serial Stenoses Within One Coronary Artery: A NXT Trial substudy. Ann Biomed Eng 44, 580–589 (2016). https://doi.org/10.1007/s10439-015-1436-y

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