Bråten Anders T, Fossan Fredrik E, Muller Lucas O, Jørgensen Arve, Stensæth Knut H, Hellevik Leif R, Wiseth Rune
Clinic of Cardiology, St. Olavs University Hospital, PO 3250 Torgarden, 7006 Trondheim, Norway.
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, PO 8900 Torgarden, 7491 Trondheim, Norway.
Eur Heart J Imaging Methods Pract. 2024 Sep 30;2(3):qyae102. doi: 10.1093/ehjimp/qyae102. eCollection 2024 Jul.
This study aims to assess the diagnostic performance of a novel computed tomography-derived fractional flow reserve (CT-FFR) algorithm and to compare its accuracy at three predefined sites: (i) at the location of invasive FFR measurements (CT-FFR), (ii) at selected sites determined by an automated module integrated within the algorithm (CT-FFR), and (iii) distally in the vessel (CT-FFR).
We prospectively recruited 108 consecutive patients with stable symptoms of coronary artery disease and at least one suspected obstructive lesion on coronary computed tomography angiography (CCTA). CT-FFR was validated against invasive FFR as gold standard using FFR ≤ 0.80 to define myocardial ischaemia. CT-FFR showed good correlation with invasive FFR ( = 0.67) and improved the ability to detect myocardial ischaemia compared with CCTA at both lesion [area under the curve (AUC) 0.83 vs. 0.65, < 0.001] and patient level (AUC 0.87 vs. 0.74, = 0.007). CT-FFR demonstrated similar diagnostic accuracy to CT-FFR and significantly improved specificity compared with CT-FFR (86% vs. 49%, < 0.001). High end CT quality improved the diagnostic performance of CT-FFR, demonstrating an AUC of 0.92; similarly, the performance was improved in patients with low-to-intermediate coronary artery calcium score with an AUC of 0.88.
Implementing an automated module to determine the site of CT-FFR evaluations was feasible, and CT-FFR demonstrated comparable diagnostic accuracy to CT-FFR when assessed against invasive FFR. Both CT-FFR and CT-FFR improved the diagnostic performance compared with CCTA and improved specificity compared with CT-FFR. High end CT quality and low-to-intermediate calcium burden improved the diagnostic performance of our algorithm.
NCT03045601.
本研究旨在评估一种新型计算机断层扫描衍生的血流储备分数（CT-FFR）算法的诊断性能，并比较其在三个预定义部位的准确性：（i）侵入性FFR测量的位置（CT-FFR），（ii）由算法中集成的自动模块确定的选定部位（CT-FFR），以及（iii）血管远端（CT-FFR）。
我们前瞻性地连续招募了108例有稳定冠心病症状且在冠状动脉计算机断层扫描血管造影（CCTA）上至少有一处疑似阻塞性病变的患者。以侵入性FFR作为金标准对CT-FFR进行验证，使用FFR≤0.80来定义心肌缺血。CT-FFR与侵入性FFR显示出良好的相关性（=0.67），并且在病变[曲线下面积（AUC）0.83对0.65，<0.001]和患者水平（AUC 0.87对0.74，=0.007）上与CCTA相比，检测心肌缺血的能力有所提高。CT-FFR与CT-FFR显示出相似的诊断准确性，并且与CT-FFR相比，特异性显著提高（86%对49%，<0.001）。高端CT质量提高了CT-FFR的诊断性能，AUC为0.92；同样，在冠状动脉钙化评分低至中等的患者中性能也有所提高，AUC为0.88。
实施自动模块来确定CT-FFR评估部位是可行的，并且在与侵入性FFR评估时，CT-FFR显示出与CT-FFR相当的诊断准确性。与CCTA相比，CT-FFR和CT-FFR均提高了诊断性能，与CT-FFR相比提高了特异性。高端CT质量和低至中等的钙化负荷提高了我们算法的诊断性能。
NCT03045601。
