Jiang Jun, Du Changqing, Hu Yumeng, Yuan Hong, Wang Jianhua, Pan Yibin, Bao Lifang, Dong Liang, Li Changling, Sun Yong, Leng Xiaochang, Xiang Jianping, Tang Lijiang, Wang Jian'an
Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Cardiology, Zhejiang Hospital, Hangzhou, China.
Quant Imaging Med Surg. 2023 Mar 1;13(3):1672-1685. doi: 10.21037/qims-22-521. Epub 2023 Feb 6.
Fractional flow reserve (FFR) is the gatekeeper for lesion-specific revascularization decision-making in patients with stable coronary artery disease (CAD). The potential of noninvasive calculation of FFR from coronary computed tomographic angiography (CCTA) to identify ischemia-causing lesions has not been sufficiently assessed. The objective of this study was to evaluate the feasibility and diagnostic accuracy of a novel computational fluid dynamics (CFD)-based technology, termed as AccuFFRct, for the diagnosis of functionally significant lesions from CCTA, using wire-based FFR as a reference standard.
A total of 191 consecutive patients who underwent CCTA and FFR measurement for suspected or known CAD were retrospectively enrolled at 2 medical centers. Three-dimensional anatomic model of coronary tree was extracted from CCTA data, CFD was applied subsequently with a novel strategy for the computation of FFR in a blinded fashion by professionals. Results were compared to invasive FFR, a threshold of ≤0.80 was used to indicate the hemodynamically relevant stenosis.
On a per-patient basis, the overall accuracy, sensitivity, specificity of AccuFFRct for detecting ischemia were 91.78% (95% CI: 86.08% to 95.68%), 92.31% (95% CI: 81.46% to 97.86%) and 91.49% (95% CI: 83.92% to 96.25%), respectively; those for per-vessel basis were 91.05% (95% CI: 86.06% to 94.70%), 92.73% (95% CI: 82.41% to 97.98%) and 90.37% (95% CI: 84.10% to 94.77%), respectively. The AccuFFRct and FFR was well correlated on per-patient (=0.709, P<0.001) and per-vessel basis (=0.655, P<0.001). The AUC of AccuFFRct determination was 0.935 (95% CI: 0.881 to 0.969) and 0.927 (95% CI: 0.880 to 0.960) on per-patient and per-vessel basis.
This novel CFD-based CCTA-derived FFR shows good diagnostic performance for detecting hemodynamic significance of coronary stenoses and may potentially become a new gatekeeper for invasive coronary angiography (ICA).
血流储备分数（FFR）是稳定型冠状动脉疾病（CAD）患者病变特异性血运重建决策的关键指标。尚未充分评估从冠状动脉计算机断层扫描血管造影（CCTA）无创计算FFR以识别缺血性病变的潜力。本研究的目的是评估一种基于计算流体动力学（CFD）的新技术AccuFFRct从CCTA诊断功能性显著病变的可行性和诊断准确性，以基于导丝的FFR作为参考标准。
在2个医学中心对191例因疑似或已知CAD接受CCTA和FFR测量的连续患者进行回顾性纳入。从CCTA数据中提取冠状动脉树的三维解剖模型，随后由专业人员采用一种新策略以盲法应用CFD计算FFR。将结果与有创FFR进行比较，使用≤0.80的阈值来指示血流动力学相关狭窄。
在个体患者层面，AccuFFRct检测缺血的总体准确性、敏感性、特异性分别为91.78%（95%CI：86.08%至95.68%）、92.31%（95%CI：81.46%至97.86%）和91.49%（95%CI：83.92%至96.25%）；在个体血管层面分别为91.05%（95%CI：86.06%至94.70%）、92.73%（95%CI：82.41%至97.98%）和90.37%（95%CI：84.10%至94.77%）。AccuFFRct与FFR在个体患者层面（=0.709，P<0.001）和个体血管层面（=0.655，P<0.001）具有良好的相关性。AccuFFRct测定的AUC在个体患者层面为0.935（95%CI：0.881至0.969），在个体血管层面为0.927（95%CI：0.880至0.960）。
这种基于CFD的新型CCTA衍生FFR在检测冠状动脉狭窄的血流动力学意义方面显示出良好的诊断性能，可能成为有创冠状动脉造影（ICA）的新关键指标。
