Author + information
- Christopher Cook1,
- Yousif Ahmad2,
- Ricardo Petraco3,
- Sukhjinder Nijjer4,
- Matthew Shun-Shin5,
- Rasha Al-Lamee6,
- Yuetsu Kikuta7,
- Yasutsugu Shiono8,
- Jamil Mayet9,
- Darrel Francis10,
- Sayan Sen11 and
- Justin Davies12
- 1Imperial College London, London, United Kingdom
- 2Imperial College London, London, United Kingdom
- 3Imperial College, London, United Kingdom
- 4Imperial College London, London, United Kingdom
- 5Imperial College London, London, United Kingdom
- 6Hammersmith Hospital, London, United Kingdom
- 7ICCH, London, United Kingdom
- 8Imperial College London, London, United Kingdom
- 9London, United Kingdom
- 10National Heart and Lung Institute, London, UK, London, United Kingdom
- 11National Heart & Lung Institute, London, United Kingdom
- 12Imperial College London NHS Trust, London, United Kingdom
FFR-CT is a novel non-invasive method for the detection of ischemia. However, the diagnostic accuracy of FFR-CT over specific ranges of disease severity is not known, impacting the utility of FFR-CT for clinical decision-making.
A systematic review was performed of studies comparing FFR-CT diagnostic performance to invasive FFR. Data were digitized and an analysis was performed comparing FFR-CT to FFR across each 0.10-unit disease quantile. FFR-CT ≤0.80 and FFR ≤0.80 was used as the diagnostic cutpoint, with FFR as the reference standard. 5 studies (908 vessels, 536 patients) were included.
The overall per-vessel diagnostic accuracy of FFR-CT was 81.9% [95% CI 79.4-84.4]. FFR-CT values 0.30 to 0.40, 0.40 to 0.50, 0.50 to 0.60, 0.60 to 0.70, 0.70 to 0.80, 0.80 to 0.90 and 0.90 to 1.0 demonstrated diagnostic accuracy for identification and exclusion of ischemia-causing lesions of 83.3% [79.4-84.4], 93.8% [92.2-95.4], 82.1% [79.6-84.6], 74.7% [71.9-77.5], 46.1% [42.9-49.3], 87.3% [85.1-89.5] and 97.9% [97.9-98.8], respectively. Between FFR-CT 0.55 to 0.85 diagnostic accuracy fell below the overall value upon which the FFR-CT technique is validated.
The diagnostic accuracy of FFR-CT varies depending on the value of the FFR-CT measurement itself. Extreme zone FFR-CT values demonstrate excellent diagnostic agreement with FFR, reliably categorizing stenoses without need for confirmatory invasive assessment. However, middle zone FFR-CT values, where the majority of patients lay, demonstrate markedly lower diagnostic accuracy and confirmatory invasive FFR is recommended.
IMAGING: FFR and Physiologic Lesion Assessment