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Experience with an on-site coronary CT-derived fractional flow reserve algorithm for the assessment of intermediate coronary stenoses

Publication
Philips CT Clinical Science Philips Healthcare • USA

Donnelly PM, Kolossváry M, Karády J, Ball PA, Kelly S, Fitzsimons D, Spence MS, Celeng C, Horváth T, Szilveszter B, van Es HW, Swaans MJ, Merkely B, Maurovich-Horvat P.

 

* This article originally appeared in the October 2017 issue of the American Journal of Cardiology.

Fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) is a new technique for the diagnosis of ischemic coronary artery stenoses. The aim of this prospective study was to evaluate the diagnostic performance of a novel on-site computed tomography-based fractional flow reserve algorithm (CT-FFR) compared with invasive FFR as the gold standard, and to determine whether its diagnostic performance is affected by interobserver variations in lumen segmentation. We enrolled 44 consecutive patients (64.6 ± 8.9 years, 34% female) with 60 coronary atherosclerotic lesions who underwent coronary CTA and invasive coronary angiography in two centers. An FFR value ≤0.8 was considered significant. Coronary CTA scans were evaluated by two expert readers, who manually adjusted the semiautomated coronary lumen segmentations for effective diameter stenosis (EDS) assessment and on-site CT-FFR simulation. The mean CT-FFR value was 0.77 ± 0.15, whereas the mean EDS was 43.6 ± 16.9%. The sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR versus EDS with a cutoff of 50% were the following: 91%, 72%, 63%, and 93% versus 52%, 87%, 69%, and 77%, respectively. The on-site CT-FFR demonstrated significantly better diagnostic performance compared with EDS (area under the curve 0.89 vs 0.74, respectively, p <0.001). The CT-FFR areas under the curve of the two readers did not show any significant difference (0.89 vs 0.88, p = 0.74). In conclusion, on-site CT-FFR simulation is feasible and has better diagnostic performance than anatomic stenosis assessment. Furthermore, the diagnostic performance of the on-site CT-FFR simulation algorithm does not depend on the readers' semi-automated lumen segmentation adjustments.
For more information about this publication, check out the PubMed listing for this article.


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Publication
Brilliance 64-channel, iCT
atherosclerosis, Cardiac, coronary angiography, coronary arteries, lesion, prospective, stenosis, Vascular
 

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