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European Radiology
Erschienen in:

06.11.2019 | Cardiac

Computed tomography angiography-derived fractional flow reserve (CT-FFR) for the detection of myocardial ischemia with invasive fractional flow reserve as reference: systematic review and meta-analysis

verfasst von: Baiyan Zhuang, Shuli Wang, Shihua Zhao, Minjie Lu

Erschienen in: European Radiology | Ausgabe 2/2020

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Abstract

Objectives

A method named computed tomography angiography-derived fractional flow reserve (FFRCT) is an alternative method for detecting hemodynamically significant coronary stenosis. We carried out a meta-analysis to derive reliable assessment of the diagnostic performances of FFRCT and compare the diagnostic accuracy with CCTA using FFR as reference.

Methods

We searched PubMed, EMBASE, The Cochrane Library, and Web of science for relevant articles published from January 2008 until May 2019 using the following search terms: FFRCT, noninvasive FFR, non-invasive FFR, noninvasive fractional flow reserve, non-invasive fractional flow reserve, and CCTA. Pooled estimates of sensitivity and specificity with the corresponding 95% confidence intervals (CIs) and the summary receiver operating characteristic curve (sROC) were determined.

Results

Sixteen studies published between 2011 and 2019 were included with a total of 1852 patients and 2731 vessels. The pooled sensitivity and specificity for FFRCT at the per-patient level was 89% (95% CI, 85–92%) and 71% (95% CI, 61–80%), respectively, while on the per-vessel basis was 85% (95% CI, 82–88%) and 82% (95% CI, 75–87%), respectively. No apparent difference in the sensitivity at per-patient and per-vessel level between FFRCT and CCTA was observed (0.89 versus 0.93 at per-patient; 0.85 versus 0.88 at per-vessel). However, the specificity of FFRCT was higher than CCTA (0.71 versus 0.32 at per-patient analysis; 0.82 versus 0.46 at per-vessel analysis).

Conclusions

FFRCT obtained a high diagnostic performance and is a viable alternative to FFR for detecting coronary ischemic lesions.

Key Points

• Noninvasive FFRCThas higher specificity for anatomical and physiological assessment of coronary artery stenosis compared with CCTA.
• Noninvasive FFRCTis a viable alternative to invasive FFR for the detection and exclusion of coronary lesions that cause ischemia.
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Literatur
1.
Laslett LJ, Alagona P Jr, Clark BA 3rd et al (2012) The worldwide environment of cardiovascular disease: prevalence, diagnosis, therapy, and policy issues: a report from the American College of Cardiology. J Am Coll Cardiol 60:S1eS49
2.
Mozaffarian D, Benjamin EJ, Go AS et al (2016) Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 133:e38iseas
3.
De Bruyne B, Pijls NH, Kalesan B et al (2012) Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 367:991–1001PubMed
4.
Task Force Members, Montalescot G, Sechtem U et al (2013) 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 34:2949–3003
5.
Matsumura M, Johnson NP, Fearon WF et al (2017) Accuracy of fractional flow reserve measurements in clinical practice: observations from a core laboratory analysis. JACC Cardiovasc Interv 10:1392–1401PubMed
6.
Xu B, Whitbourn R, Wilson A et al (2014) Clinical impact of fractional flow reserve in a real-world cohort of patients. Int J Cardiol 172:251–252PubMed
7.
Min JK, Feignoux J, Treutenaere J, Laperche T, Sablayrolles J (2010) The prognostic value of multidetector coronary CT angiography for the prediction of major adverse cardiovascular events: a multicenter observational cohort study. Int J Cardiovasc Imaging 26:721–728PubMed
8.
Andrew M, John H (2015) The challenge of coronary calcium on coronary computed tomographic angiography (CCTA) scans: effect on interpretation and possible solutions. Int J Cardiovasc Imaging 31:145–157PubMed
9.
Arbab-Zadeh A, Hoe J (2011) Quantification of coronary arterial stenoses by multidetector CT angiography in comparison with conventional angiography methods, caveats, and implications. JACC Cardiovasc Imaging 4:191–202PubMed
10.
Taylor CA, Fonte TA, Min JK (2013) Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve. J Am Coll Cardiol 61:2233–2241PubMed
11.
Gaur S, Ovrehus KA, Dey D et al (2016) Coronary plaque quantification and fractional flow reserve by coronary computed tomography angiography identify ischaemia-causing lesions. Eur Heart J 37:1220–1227PubMedPubMedCentral
12.
Kim KH, Doh JH, Koo BK et al (2014) A novel noninvasive technology for treatment planning using virtual coronary stenting and computed tomography-derived computed fractional flow reserve. JACC Cardiovasc Interv 7:72–78PubMed
13.
Norgaard BL, Leipsic J, Koo BK et al (2016) Coronary computed tomography angiography derived fractional flow reserve and plaque stress. Curr Cardiovasc Imaging Rep 9:2PubMedPubMedCentral
14.
Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the Prisma statement. Ann Intern Med 4(264-9):W64
15.
Bossuyt PM, Reitsma JB, Bruns DE et al (2015) STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies 1. Radiology 272:826–832
16.
Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH (2005) Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 58(10):982–990PubMed
17.
Higgins JP, Thompson SG, Deek JJ et al (2003) Measuring inconsistency in meta-analyses. BMJ 327:557in60
18.
Irwig L, Tosteson AN, Gatsonis C et al (1994) Guidelines for meta-analyses evaluating diagnostic tests. Ann Intern Med 120:667es f
19.
Jones CM, Athanasiou T (2005) Summary receiver operating characteristic curve analysis techniques in the evaluation of diagnostic tests. Ann Thorac Surg 79:16–20PubMed
20.
Deeks JJ, Macaskill P, Irwig L (2005) The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 58:882–893PubMed
21.
Jaeschke R, Guyatt GH, Sackett DL (1994) Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA 271(9):703–707PubMed
22.
Ko BS, Wong DT, Cameron JD et al (2014) 320-row CT coronary angiography predicts freedom from revascularisation and acts as a gatekeeper to defer invasive angiography in stable coronary artery disease: a fractional flow reserve-correlated study. Eur Radiol 24:738–747PubMed
23.
Wardziak L, Kruk M, Pleban W et al (2019) Coronary CTA enhanced with CTA based FFR analysis provides higher diagnostic value than invasive coronary angiography in patients with intermediate coronary stenosis. J Cardiovasc Comput Tomogr 13(1):62–67PubMed
24.
Koo BK, Erglis A, Doh JH et al (2011) Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol 58:1989–1997PubMed
25.
Min JK, Leipsic J, Pencina MJ et al (2012) Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA 308:1237–1245PubMedPubMedCentral
26.
Norgaard BL, Leipsic J, Gaur S et al (2014) Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol 63:1145–1155PubMed
27.
Renker M, Schoepf UJ, Wang R et al (2014) Comparison of diagnostic value of a novel noninvasive coronary computed tomography angiography method versus standard coronary angiography for assessing fractional flow reserve. Am J Cardiol 114:1303–1308PubMed
28.
Wang R, Renker M, Schoepf UJ et al (2015) Diagnostic value of quantitative stenosis predictors with coronary CT angiography compared to invasive fractional flow reserve. Eur J Radiol 84:1509–1515PubMed
29.
Coenen A, Lubbers MM, Kurata A et al (2015) Fractional flow reserve computed from non-invasive CT angiography data: diagnostic performance of an on-site clinician operated computational fluid dynamics algorithm 1. Radiology 274:674–683PubMed
30.
Min JK, Koo BK, Erglis A et al (2012) Usefulness of noninvasive fractional flow reserve computed from coronary computed tomographic angiograms for intermediate stenoses confirmed by quantitative coronary angiography. Am J Cardiol 110:971–976PubMed
31.
Wong DT, Ko BS, Cameron JD et al (2013) Transluminal attenuation gradient in coronary computed tomography angiography is a novel noninvasive approach to the identification of functionally significant coronary artery stenosis: a comparison with fractional flow reserve. J Am Coll Cardiol 61:1271–1279PubMed
32.
Tesche C, De Cecco CN, Caruso D et al (2016) Coronary CT angiography derived morphological and functional quantitative plaque markers correlated with invasive fractional flow reserve for detecting hemodynamically significant stenosis. J Cardiovasc Comput Tomogr 10:199–206PubMed
33.
Ko BS, Cameron JD, Munnur RK et al (2017) Noninvasive CT-derived FFR based on structural and fluid analysis: a comparison with invasive FFR for detection of functionally significant stenosis. JACC Cardiovasc Imaging 10:663–673PubMed
34.
Kruk M, Wardziak L, Demkow M et al (2016) Workstation-based calculation of CTA-based FFR for intermediate stenosis. JACC Cardiovasc Imaging 9:690–699PubMed
35.
Chung JH, Lee KE, Nam CW et al (2017) Diagnostic performance of a novel method for fractional flow reserve computed from noninvasive computed tomography angiography (NOVEL-FLOW Study). Am J Cardiol 120(3):362–368PubMed
36.
Rother J, Moshage M, Dey D et al (2018) Comparison of invasively measured FFR with FFR derived from coronary CT angiography for detection of lesion-specific ischemia: results from a PC-based prototype algorithm. J Cardiovasc Comput Tomogr 12(2):101–107PubMed
37.
Sand NPR, Veien KT, Nielsen SS et al (2018) Prospective comparison of FFR derived from coronary CT angiography with SPECT perfusion imaging in stable coronary artery disease: the ReASSESS study. JACC Cardiovasc Imaging 11(11):1640–1650PubMed
38.
von Knebel Doeberitz PL, De Cecco CN, Schoepf UJ et al (2019) Coronary CT angiography-derived plaque quantification with artificial intelligence CT fractional flow reserve for the identification of lesion-specific ischemia. Eur Radiol 29(5):2378–2387
39.
Abdulla J, Abildstrom SZ, Gotzsche O, Christensen E, Kober L, Torp-Pedersen C (2007) 64-multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and meta-analysis. Eur Heart J 28(24):3042–3050PubMed
40.
Schuijf JD, Achenbach S, de Feyter PJ, Bax JJ (2011) Current applications and limitations of coronary computed tomography angiography in stable coronary artery disease. Heart 97(4):330–337PubMed
41.
Yu M, Lu Z, Shen C et al (2019) The best predictor of ischemic coronary stenosis: subtended myocardial volume, machine learning-based FFRCT, or high-risk plaque features? Eur Radiol 29(7):3647–3657PubMed
42.
Norgaard BL, Gaur S, Leipsic J et al (2015) Influence of coronary calcification on the diagnostic performance of CT angiography derived FFR in coronary artery disease: a substudy of the NXT Trial. JACC Cardiovasc Imaging 8(9):1045–1055PubMed
43.
Liu X, Wang Y, Zhang H et al (2019) Evaluation of fractional flow reserve in patients with stable angina: can CT compete with angiography? Eur Radiol 29(7):3669–3677PubMed
44.
Cook CM, Petraco R, Shun-Shin MJ et al (2017) Diagnostic accuracy of computed tomography–derived fractional flow reserve. JAMA Cardiol 2(7):803PubMed
45.
Baumann S, Renker M, Hetjens S et al (2016) Comparison of coronary computed tomography angiography-derived vs invasive fractional flow reserve assessment: meta-analysis with subgroup evaluation of intermediate stenosis. Acad Radiol 23(11):1402–1411PubMed
46.
Celeng C, Leiner T, Maurovich-Horvat P et al (2018) Anatomical and functional computed tomography for diagnosing hemodynamically significant coronary artery disease: a metaanalysis. JACC Cardiovasc Imaging 12:1316–1325
47.
Gonzalez JA, Lipinski MJ, Flors L, Shaw PW, Kramer CM, Salerno M (2015) Meta-analysis of diagnostic performance of coronary computed tomography angiography, computed tomography perfusion, and computed tomography-fractional flow reserve in functional myocardial ischemia assessment versus invasive fractional flow reserve. Am J Cardiol 116:1469–1478PubMedPubMedCentral
48.
Deng SB, Jing XD, Wang J et al (2015) Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in coronary artery disease: a systematic review and meta-analysis. Int J Cardiol 184:703–709PubMed
49.
Caruso D, Eid M, Schoepf UJ et al (2016) Dynamic CT myocardial perfusion imaging. Eur J Radiol 85:1893–1899PubMed
50.
Melikian N, De Bondt P, Tonino P et al (2010) Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease. JACC Cardiovasc Interv 3:307–314PubMed
51.
Heydari B, Jerosch-Herold M, Kwong RY (2011) Assessment of myocardial ischemia with cardiovascular magnetic resonance. Prog Cardiovasc Dis 54:191–203PubMedPubMedCentral
52.
Bech GJ, De Bruyne B, Pijls NH et al (2001) Fractional flow reserve to determine the appropriateness of angioplasty in moderate coronary stenosis: a randomized trial. Circulation 103(24):2928–2934PubMed
53.
Tesche C, Vliegenthart R, Duguay TM et al (2017) Coronary computed tomographic angiography-derived fractional flow reserve for therapeutic decision making. Am J Cardiol 120(12):2121–2127PubMed
54.
Leipsic J, Yang TH, Thompson A et al (2014) CT angiography (CTA) and diagnostic performance of noninvasive fractional flow reserve: results from the determination of fractional flow reserve by anatomic CTA (DeFACTO) Study. AJR Am J Roentgenol 202:989–994PubMed
55.
Siogkas PK, Anagnostopoulos CD, Liga R et al (2019) Noninvasive CT-based hemodynamic assessment of coronary lesions derived from fast computational analysis: a comparison against fractional flow reserve. Eur Radiol 29(4):2117–2126PubMed
Metadaten
Titel
Computed tomography angiography-derived fractional flow reserve (CT-FFR) for the detection of myocardial ischemia with invasive fractional flow reserve as reference: systematic review and meta-analysis
verfasst von
Baiyan Zhuang
Shuli Wang
Shihua Zhao
Minjie Lu
Publikationsdatum
06.11.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 2/2020
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06470-8

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