Diagnostic performance of corrected FFR metrics to predict hemodynamically significant coronary artery stenosis.

OBJECTIVES

To determine the diagnostic performance of the fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA) (FFR) difference across the lesion (ΔFFR) or the vessel (ΔFFR) and the gradient of FFR 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. ΔFFR, ΔFFR, and FFR gradient were calculated. Performance characteristics of different corrected FFR metrics in detecting ischemic stenosis were analyzed. Impacts of coronary calcification and lesion length on the corrected FFR metrics were also analyzed.

RESULTS

The diagnostic sensitivities, specificities, and accuracies of 94.4%, 88.7%, and 91.0% with ΔFFR, 57.1%, 72.3%, and 65.2% with ΔFFR, and 50.0%, 85.1%, and 68.5% with FFR gradient, respectively, were detected. There was higher specificity, accuracy, and area under the curve (AUC) for ΔFFR compared with CCTA (p < 0.05 for all). The specificity and AUC of FFR gradient and ΔFFR were significantly higher than CCTA (p < 0.05 for all). Coronary calcification showed no impact on corrected FFR metrics. ΔFFR for lesion length ratio (LLR) < 1/10 was significantly lower than that for LLR 1/10 to 3/10 and LLR > 3/10.

CONCLUSIONS

ΔFFR was significantly correlated with the hemodynamically significant coronary artery stenosis. ΔFFR had the potential to be immediately used in real-world practice to discriminate ischemic coronary artery stenosis.

KEY POINTS

• The difference of FFR across the lesion or the vessel and the gradient of FFR was related to the hemodynamically significant coronary artery stenosis. • The difference of FFR across the lesion showed the best diagnostic performance in detecting the hemodynamically significant coronary artery stenosis. • Coronary calcification showed no impact on corrected FFR metrics, while lesion length related to the difference of FFR across the lesion.