A Novel CT Perfusion-Based Fractional Flow Reserve Algorithm for Detecting Coronary Artery Disease

• Published in: Journal of clinical medicine Vol. 12; no. 6; p. 2154
• Main Authors: Gao, Xuelian, Wang, Rui, Sun, Zhonghua, Zhang, Hongkai, Bo, Kairui, Xue, Xiaofei, Yang, Junjie, Xu, Lei
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 09.03.2023; MDPI
• Subjects: Accuracy; Algorithms; Boundary conditions; Cardiovascular disease; Clinical medicine; Computer-aided medical diagnosis; Coronary heart disease; Coronary vessels; CT imaging; Diagnosis; Fluid dynamics; Hemodynamics; Ischemia; Medical imaging; Methods; Myocardial ischemia; Open source software; Physiology; Radiation; Tomography; Vein & artery diseases; China; United States > US; Germany; coronary artery disease; myocardial ischemia; fractional flow reserve from CT angiography; fractional flow reserve; computed tomographic perfusion
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12062154

Background: The diagnostic accuracy of fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA) (FFR-CT) needs to be further improved despite promising results available in the literature. While an innovative myocardial computed tomographic perfusion (CTP)-derived fractional flow reserve (CTP-FFR) model has been initially established, the feasibility of CTP-FFR to detect coronary artery ischemia in patients with suspected coronary artery disease (CAD) has not been proven. Methods: This retrospective study included 93 patients (a total of 103 vessels) who received CCTA and CTP for suspected CAD. Invasive coronary angiography (ICA) was performed within 2 weeks after CCTA and CTP. CTP-FFR, CCTA (stenosis ≥ 50% and ≥70%), ICA, FFR-CT and CTP were assessed by independent laboratory experts. The diagnostic ability of the CTP-FFR grouped by quantitative coronary angiography (QCA) in mild (30–49%), moderate (50–69%) and severe stenosis (≥70%) was calculated. The effect of calcification of lesions, grouped by FFR on CTP-FFR measurements, was also assessed. Results: On the basis of per-vessel level, the AUCs for CTP-FFR, CTP, FFR-CT and CCTA were 0.953, 0.876, 0.873 and 0.830, respectively (all p < 0.001). The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CTP-FFR for per-vessel level were 0.87, 0.88, 0.87, 0.85 and 0.89 respectively, compared with 0.87, 0.54, 0.69, 0.61, 0.83 and 0.75, 0.73, 0.74, 0.70, 0.77 for CCTA ≥ 50% and ≥70% stenosis, respectively. On the basis of per-vessel analysis, CTP-FFR had higher specificity, accuracy and AUC compared with CCTA and also higher AUC compared with FFR-CT or CTP (all p < 0.05). The sensitivity and accuracy of CTP-FFR + CTP + FFR-CT were also improved over FFR-CT alone (both p < 0.05). It also had improved specificity compared with FFR-CT or CTP alone (p < 0.01). A strong correlation between CTP-FFR and invasive FFR values was found on per-vessel analysis (Pearson’s correlation coefficient 0.89). The specificity of CTP-FFR was higher in the severe calcification group than in the low calcification group (p < 0.001). Conclusions: A novel CTP-FFR model has promising value to detect myocardial ischemia in CAD, particularly in mild-to-moderate stenotic lesions.