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  • Title: Diagnostic performance of corrected FFRCT metrics to predict hemodynamically significant coronary artery stenosis.
    Author: Wen D, Zhao H, Zhong S, Li C, Liu B, An R, Zheng M.
    Journal: Eur Radiol; 2021 Dec; 31(12):9232-9239. PubMed ID: 34080038.
    Abstract:
    OBJECTIVES: To determine the diagnostic performance of the fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA) (FFRCT) difference across the lesion (ΔFFRCT lesion) or the vessel (ΔFFRCT vessel) and the gradient of FFRCT for the identification of hemodynamically significant coronary stenosis. METHODS: From June 2016 to December 2018, 73 patients suspected of having coronary artery disease who underwent CCTA followed invasive coronary angiography (ICA) within 1 month were retrospectively included. ΔFFRCT lesion, ΔFFRCT vessel, and FFRCT gradient were calculated. Performance characteristics of different corrected FFRCT metrics in detecting ischemic stenosis were analyzed. Impacts of coronary calcification and lesion length on the corrected FFRCT metrics were also analyzed. RESULTS: The diagnostic sensitivities, specificities, and accuracies of 94.4%, 88.7%, and 91.0% with ΔFFRCT lesion, 57.1%, 72.3%, and 65.2% with ΔFFRCT vessel, and 50.0%, 85.1%, and 68.5% with FFRCT gradient, respectively, were detected. There was higher specificity, accuracy, and area under the curve (AUC) for ΔFFRCT lesion compared with CCTA (p < 0.05 for all). The specificity and AUC of FFRCT gradient and ΔFFRCT vessel were significantly higher than CCTA (p < 0.05 for all). Coronary calcification showed no impact on corrected FFRCT metrics. ΔFFRCT lesion for lesion length ratio (LLR) < 1/10 was significantly lower than that for LLR 1/10 to 3/10 and LLR > 3/10. CONCLUSIONS: ΔFFRCT lesion was significantly correlated with the hemodynamically significant coronary artery stenosis. ΔFFRCT lesion had the potential to be immediately used in real-world practice to discriminate ischemic coronary artery stenosis. KEY POINTS: • The difference of FFRCT across the lesion or the vessel and the gradient of FFRCT was related to the hemodynamically significant coronary artery stenosis. • The difference of FFRCT across the lesion showed the best diagnostic performance in detecting the hemodynamically significant coronary artery stenosis. • Coronary calcification showed no impact on corrected FFRCT metrics, while lesion length related to the difference of FFRCT across the lesion.
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