Diagnosis of Ischemia-Causing Coronary Stenoses by Noninvasive Fractional Flow Reserve Computed From Coronary Computed Tomographic Angiograms

Autor: Jonathan Leipsic, Sanda Jegere, Andrejs Erglis, Allison Dunning, Joon Hyung Doh, David V. Daniels, Tony DeFrance, James K. Min, Bon-Kwon Koo, Hyo-Soo Kim, Alexandra J. Lansky
Rok vydání: 2011
Předmět:
Zdroj: Journal of the American College of Cardiology. 58:1989-1997
ISSN: 0735-1097
Popis: Objectives The aim of this study was to determine the diagnostic performance of a new method for quantifying fractional flow reserve (FFR) with computational fluid dynamics (CFD) applied to coronary computed tomography angiography (CCTA) data in patients with suspected or known coronary artery disease (CAD). Background Measurement of FFR during invasive coronary angiography is the gold standard for identifying coronary artery lesions that cause ischemia and improves clinical decision-making for revascularization. Computation of FFR from CCTA data (FFR CT ) provides a noninvasive method for identifying ischemia-causing stenosis; however, the diagnostic performance of this new method is unknown. Methods Computation of FFR from CCTA data was performed on 159 vessels in 103 patients undergoing CCTA, invasive coronary angiography, and FFR. Independent core laboratories determined FFR CT and CAD stenosis severity by CCTA. Ischemia was defined by an FFR CT and FFR ≤0.80, and anatomically obstructive CAD was defined as a CCTA with stenosis ≥50%. Diagnostic performance of FFR CT and CCTA stenosis was assessed with invasive FFR as the reference standard. Results Fifty-six percent of patients had ≥1 vessel with FFR ≤0.80. On a per-vessel basis, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 84.3%, 87.9%, 82.2%, 73.9%, 92.2%, respectively, for FFR CT and were 58.5%, 91.4%, 39.6%, 46.5%, 88.9%, respectively, for CCTA stenosis. The area under the receiver-operator characteristics curve was 0.90 for FFR CT and 0.75 for CCTA (p = 0.001). The FFR CT and FFR were well correlated (r = 0.717, p CT (0.022 ± 0.116, p = 0.016). Conclusions Noninvasive FFR derived from CCTA is a novel method with high diagnostic performance for the detection and exclusion of coronary lesions that cause ischemia. (The Diagnosis of ISChemia-Causing Stenoses Obtained Via NoninvasivE FRactional FLOW Reserve; NCT01189331)
Databáze: OpenAIRE