On-site assessment of computed tomography-derived fractional flow reserve in comparison with myocardial perfusion imaging and invasive fractional flow reserve

• Published in: Heart and vessels Vol. 35; no. 10; pp. 1331 - 1340
• Main Authors: Miyajima, Keiichi, Motoyama, Sadako, Sarai, Masayoshi, Kawai, Hideki, Nagahara, Yasuomi, Matsumoto, Ryota, Fujiwara, Wakaya, Muramatsu, Takashi, Takahashi, Hiroshi, Naruse, Hiroyuki, Ishii, Junnichi, Kondo, Takeshi, Narula, Jagat, Izawa, Hideo, Ozaki, Yukio
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.10.2020; Springer Nature B.V
• Subjects: Aged; Angiography; Biomedical Engineering and Bioengineering; Cardiac Catheterization; Cardiac Surgery; Cardiology; Cardiovascular disease; Computed tomography; Computed Tomography Angiography; Coronary Angiography; Coronary artery; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - physiopathology; Diagnostic systems; Female; Fractional Flow Reserve, Myocardial; Heart diseases; Humans; Ischemia; Lesions; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Multidetector Computed Tomography; Myocardial Perfusion Imaging; Original Article; Performance evaluation; Perfusion; Photon emission; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Severity of Illness Index; Single photon emission computed tomography; Stenosis; Tomography; Tomography, Emission-Computed, Single-Photon; Vascular Surgery; Workstations; Invasive FFR; Coronary artery disease; MPI; CT-FFR
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-020-01606-z

Myocardial perfusion imaging (MPI) using Single Photon Emission Computed Tomography has been established as a standard noninvasive tool for risk stratification of coronary artery disease (CAD). We evaluated the diagnostic performance of on-site workstation-based computed tomography-derived fractional flow reserve (CT-FFR) in comparison with MPI using invasive fractional flow reserve (invasive FFR) as a gold standard. We enrolled 97 patients with suspected CAD. Diagnostic performance of CT angiography (CTA), and CT-FFR was compared in 105 lesions of 97 patients. Invasive FFR ≤ 0.8 was detected in 38 (36%) lesions. Diagnostic performance of CT-FFR was improved compared with CTA (AUC 0.83 vs. 0.60, p  < 0.0001). The lesions with both CTA and MPI findings ( n  = 47), invasive FFR ≤ 0.8 was detected in 19 (40.4) lesions. CT-FFR (AUC 0.81, 95% CI 0.72–0.94) significantly improved diagnostic performance compared with CTA-50% (AUC 0.59, p  = 0.00019) and MPI (AUC 0.64, p  = 0.0082). In lesions with ≥ 50% on CTA ( n  = 42), diagnostic accuracy of CT-FFR (AUC 0.81) was significantly superior to MPI (AUC 0.64, p  = 0.0239). In conclusions, CT-FFR improved diagnostic accuracy to detect invasive FFR ≤ 0.8 compared with luminal stenosis on CTA and ischemia on MPI. Patients with ≥ 50% stenosis on CTA would be the candidates for CT-FFR.