Monash Cardiovascular Research Centre, Monash University and MonashHEART, Monash Health, Melbourne, Vic, Australia.
Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Heart Lung Circ. 2022 Aug;31(8):1102-1109. doi: 10.1016/j.hlc.2022.03.008. Epub 2022 Apr 29.
Non-invasive computed tomography (CT)-derived fractional flow reserve (FFR) is computed from standard coronary CT angiography (CTA) datasets and provides accurate vessel-specific ischaemia assessment of coronary artery disease (CAD). To date, the technique and its diagnostic performance has not been verified in the Australian clinical context. The aim of this study was to describe and compare the diagnostic performance of FFR and CTA for the detection of vessel-specific ischaemia as determined by invasive fractional flow reserve (FFR) in the Australian patient population.
One-hundred-and-nine patients (219 vessels) referred for clinically mandated invasive angiography were retrospectively assessed. Each patient underwent research mandated CTA and FFR within 3 months of invasive angiography and invasive FFR assessment. Independent core laboratory assessments were made to determine visual CTA stenosis, FFR and invasive FFR values. FFR values were matched with the corresponding invasive FFR measurement taken at the given wire position. Visual CTA stenosis ≥50%, FFR values ≤0.8 and invasive FFR values ≤0.8 were considered significant for ischaemia.
Per vessel accuracy, sensitivity, specificity, positive predictive value and negative predictive value of FFR were 80.4%, 80.0%, 80.6%, 64.9% and 90.0% respectively. Corresponding values for CTA were 75.1%, 87.1%, 69.2%, 58.1% and 91.7% respectively. In receiver operating characteristic curve analysis, FFR demonstrated superior area under the curve (AUC) compared with CTA in both per vessel (0.87 vs 0.77, p=0.004) and per patient analysis (0.86 vs 0.74, p=0.011). Per vessel AUC of combined CTA and FFR was superior to CTA alone (0.89 vs 0.77, p<0.0001).
In this cohort of Australian patients, the diagnostic performance of FFR was found to be comparable to existing international literature, with demonstrated improvement in performance compared with CTA alone for the detection of vessel-specific ischaemia.
无创计算机断层扫描（CT）衍生的血流储备分数（FFR）是从标准冠状动脉 CT 血管造影（CTA）数据集中计算得出的，可对冠状动脉疾病（CAD）进行准确的血管特异性缺血评估。迄今为止，该技术及其诊断性能尚未在澳大利亚临床环境中得到验证。本研究的目的是描述和比较 FFR 和 CTA 在检测澳大利亚患者人群中特定血管缺血方面的诊断性能，这些缺血是通过有创血流储备分数（FFR）确定的。
回顾性评估了 109 名（219 支血管）因临床需要进行有创血管造影的患者。每位患者在有创血管造影和 3 个月内进行了有创 FFR 检查。独立的核心实验室评估确定了视觉 CTA 狭窄、FFR 和有创 FFR 值。FFR 值与特定导丝位置的相应有创 FFR 测量值相匹配。视觉 CTA 狭窄≥50%、FFR 值≤0.8 和有创 FFR 值≤0.8 被认为与缺血有关。
每支血管的准确性、敏感度、特异度、阳性预测值和阴性预测值，FFR 分别为 80.4%、80.0%、80.6%、64.9%和 90.0%。相应的 CTA 值分别为 75.1%、87.1%、69.2%、58.1%和 91.7%。在接受者操作特征曲线分析中，FFR 在每支血管（0.87 比 0.77，p=0.004）和每位患者（0.86 比 0.74，p=0.011）的分析中，均表现出优于 CTA 的曲线下面积（AUC）。联合 CTA 和 FFR 的每支血管 AUC 优于 CTA 单独使用（0.89 比 0.77，p<0.0001）。
在本澳大利亚患者队列中，FFR 的诊断性能与现有的国际文献相当，与 CTA 单独使用相比，其检测特定血管缺血的性能得到了改善。
