Machine learning-based CT fractional flow reserve assessment in acute chest pain: first experience.

BACKGROUND

Computed tomography (CT)-derived fractional flow reserve (FFR) enables the non-invasive functional assessment of coronary artery stenosis. We evaluated the feasibility and potential clinical role of FFR in patients presenting to the emergency department with acute chest pain who underwent chest-pain CT (CPCT).

METHODS

For this retrospective IRB-approved study, we included 56 patients (median age: 62 years, 14 females) with acute chest pain who underwent CPCT and who had at least a mild (≥25% diameter) coronary artery stenosis. CPCT was evaluated for the presence of acute plaque rupture and vulnerable plaque features. FFR measurements were performed using a machine learning-based software. We assessed the agreement between the results from FFR and patient outcome (including results from invasive catheter angiography and from any non-invasive cardiac imaging test, final clinical diagnosis and revascularization) for a follow-up of 3 months.

RESULTS

FFR was technically feasible in 38/56 patients (68%). Eleven of the 38 patients (29%) showed acute plaque rupture in CPCT; all of them underwent immediate coronary revascularization. Of the remaining 27 patients (71%), 16 patients showed vulnerable plaque features (59%), of whom 11 (69%) were diagnosed with acute coronary syndrome (ACS) and 10 (63%) underwent coronary revascularization. In patients with vulnerable plaque features in CPCT, FFRCT had an agreement with outcome in 12/16 patients (75%). In patients without vulnerable plaque features (n=11), one patient showed myocardial ischemia (9%). In these patients, FFR and patient outcome showed an agreement in 10/11 patients (91%).

CONCLUSIONS

Our preliminary data show that FFR is feasible in patients with acute chest pain who undergo CPCT provided that image quality is sufficient. FFR has the potential to improve patient triage by reducing further downstream testing but appears of limited value in patients with CT signs of acute plaque rupture.