Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(02): 291-296
DOI: 10.1055/s-0041-1734363
Original Article

Onsite Computed Tomography Fractional Flow Reserve in Patients with Suspected Stable Coronary Artery Disease Initial Experience

Atul Kapoor
1   Department of Computed Tomography, Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India
,
Goldaa Mahajan
1   Department of Computed Tomography, Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India
,
Aprajita Kapoor
1   Department of Computed Tomography, Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction Computed tomographic coronary angiographic (CTCA) has evolved into a robust technique to detect significant stenosis; however, there is a discordance in the anatomic and functional significance of stenosis. Therefore, patients with stable coronary artery disease need to be further evaluated before deciding for any revascularization procedure.

Material and Methods A total of 100 consecutive patients of suspected stable coronary artery disease who underwent CTCA were evaluated for functional significance of lesions using onsite computed tomography fractional flow reserve (CTFFR) and the results were compared for detection of both significant and hemodynamically significant/severe stenosis on per vessel and per patient basis and differences were statistically analyzed. Impact of these differences were analyzed for the final outcome and management plan.

Results CTCA detected 33 patients with severe stenosis, while 54 patients had hemodynamically significant stenosis on CTFFR. The sensitivity and specificity of CTCA for the detection of significant coronary artery stenosis per vessel basis were 97.7 and 93.3%, respectively, with a negative predictive value of 98.0%. For severe coronary artery stenosis, sensitivity, specificity, and negative and positive predictive values were 51.6, 89, 68.8, and 80%, respectively, on per vessel basis with CTCA. On per patient basis, CTCA showed as sensitivity and specificity of 61 and 84%, respectively, with area under curve (AUC) being 0.92 and 0.67 for significant and severe stenosis, respectively.

Discussion Onsite CTFFR is a useful tool to calculate functionally significant stenosis and also improves the sensitivity and specificity of CTCA. CTFFR detected 12% more stenotic vessels in the present study on per vessel basis and 21% on per patient basis.

Keywords

computed tomographic coronary angiography - coronary artery disease - CTFFR


Publication History

Article published online:
28 July 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Zhang LJ, Wu SY, Wang J. et al. Diagnostic accuracy of dual-source CT coronary angiography: The effect of average heart rate, heart rate variability, and calcium score in a clinical perspective. Acta Radiol 2010; 51 (07) 727-740
    CrossrefPubMedGoogle Scholar
  • 2 National Institute for Health and Clinical Excellence. Chest Pain of Recent Onset: Assessment and Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin. CG95. London, United Kingdom: National Institute for Health and Clinical Excellence 2016
  • 3 Douglas PS, Hoffmann U, Patel MR. et al. PROMISE Investigators. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med 2015; 372 (14) 1291-1300
    CrossrefPubMedGoogle Scholar
  • 4 SCOT-HEART investigators CT coronary angiography in patients with suspected angina due to coronary artery disease (SCOT-HEART): An open-label, parallel group multicentre trial. Lancet 2015; 285: 2383-2391
    Google Scholar
  • 5 Budoff MJ, Dowe D, Jollis JG. et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 2008; 52 (21) 1724-1732
    CrossrefPubMedGoogle Scholar
  • 6 Pijls NH, De Bruyne B, Peels K. et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 1996; 334 (26) 1703-1708
    CrossrefPubMedGoogle Scholar
  • 7 De Bruyne B, Pijls NH, Kalesan B. et al. FAME 2 Trial Investigators. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 2012; 367 (11) 991-1001
    CrossrefPubMedGoogle Scholar
  • 8 Meijboom WB, Van Mieghem CA, van Pelt N. et al. Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol 2008; 52 (08) 636-643
    CrossrefPubMedGoogle Scholar
  • 9 Formaggia L Quarteroni A Veneziani A Cardiovascular Mathematics: Modeling and Simulation of the Circulatory System. Vol. 1. Heidelberg, Germany: Springer Science & Buisness Media; 2010 Murray CD. Proc Natl Acad Sci U S A 1926; 12 (03) 207-214
    CrossrefPubMedGoogle Scholar
  • 10 Taylor CA, Fonte TA, Min JK. Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis. J Am Coll Cardiol 2013; 61 (22) 2233-2241
    CrossrefPubMedGoogle Scholar
  • 11 Ihdayhid AR, Sakaguchi T, Linde JJ. et al. Performance of computed tomography-derived fractional flow reserve using reduced-order modelling and static computed tomography stress myocardial perfusion imaging for detection of haemodynamically significant coronary stenosis. Eur Heart J Cardiovasc Imaging 2018; 19 (11) 1234-1243
    CrossrefPubMedGoogle Scholar
  • 12 Andreini D, Modolo R, Katagiri Y. et al. SYNTAX III REVOLUTION Investigators. Impact of fractional flow reserve derived from coronary computed tomography angiography on heart team treatment decision-making in patients with multivessel coronary artery disease. Circ Cardiovasc Interv 2019; 12 (12) e007607
    CrossrefPubMedGoogle Scholar
  • 13 Nørgaard BL, Gaur S, Leipsic J. et al. Influence of coronary calcification on the diagnostic performance of CT angiography derived FFR in coronary artery disease: a substudy of the NXT trial. JACC Cardiovasc Imaging 2015; 8 (09) 1045-1055
    CrossrefPubMedGoogle Scholar
  • 14 Pepine CJ, Ferdinand KC, Shaw LJ. et al. ACC CVD in Women Committee. Emergence of nonobstructive coronary artery disease: a woman’s problem and need for change in definition on angiography. J Am Coll Cardiol 2015; 66 (17) 1918-1933
    CrossrefPubMedGoogle Scholar