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

Keiichi Miyajima, Sadako Motoyama, Masayoshi Sarai, Hideki Kawai, Yasuomi Nagahara, Ryota Matsumoto, Wakaya Fujiwara, Takashi Muramatsu, Hiroshi Takahashi, Hiroyuki Naruse, Junnichi Ishii, Takeshi Kondo, Jagat Narula, Hideo Izawa, Yukio Ozaki

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
JournalHeart and Vessels
DOIs
Publication statusAccepted/In press - 01-01-2020

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Miyajima, K., Motoyama, S., Sarai, M., Kawai, H., Nagahara, Y., Matsumoto, R., Fujiwara, W., Muramatsu, T., Takahashi, H., Naruse, H., Ishii, J., Kondo, T., Narula, J., Izawa, H., & Ozaki, Y. (Accepted/In press). On-site assessment of computed tomography-derived fractional flow reserve in comparison with myocardial perfusion imaging and invasive fractional flow reserve. Heart and Vessels. https://doi.org/10.1007/s00380-020-01606-z