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The diagnostic performance of on-site workstation-based computed tomography-derived fractional flow reserve. Comparison with myocardium perfusion imaging

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Abstract

To compare the diagnostic performance of on-site workstation-based computed tomography-derived fractional flow reserve (CT-FFR)Few data of CT-FFR were reported regarding the diagnostic performance for detecting hemodynamically significant coronary artery disease (CAD). This retrospective single-center analysis included 132 vessels in 77 patients who underwent CT angiography, myocardial perfusion imaging (MPI), and invasive FFR. The correlation coefficient between CT-FFR and invasive FFR and optimal cut-off value for CT-FFR to identify invasive FFR ≤ 0.8 were evaluated. The diagnostic accuracies of CT- FFR, and MPI were evaluated using an area under the receiver-operating characteristic curve (AUC) with invasive FFR as a reference standard. Diagnostic performance of CT-FFR was also evaluated concerning lesion characteristics, including intermediate lesions, left main lesions, tandem lesions, and/or diffuse lesions, and coronary calcium (Agatston score over 400). The Receiver Operating Characteristic curve analysis showed that the optimal cut-off value of CT-FFR for detecting invasive FFR ≤ 0.80 was 0.80 [AUC = 0.83, 95%CI: 0.76–0.90). Diagnostic sensitivity, specificity, positive and negative predictive value, and accuracy of CT-FFR when compared with those of MPI regarding per-patient analysis were 93% vs. 63%, 48% vs. 61%, 81% vs. 79%, 73% vs. 41%, and 79% vs. 62%, respectively, and for per-vessel analysis were 89% vs. 24%, 66% vs. 82%, 75% vs. 61%, 83% vs. 48%, and 78% vs. 51%, respectively. The AUC of the CT-FFR was significantly higher than MPI (0.83 vs. 0.57, p < 0.0001) regarding the per-vessel analysis. No differences in the diagnostic performance of CT-FFR were noted in the presence of intermediate lesions, left main lesions, tandem lesions, and/or diffuse lesions, and severe coronary calcium. On-site CT-FFR delivered a higher diagnostic performance than MPI for detecting CAD with invasive FFR ≤ 0.8, indicating the potential of CT-FFR as the gatekeeper of invasive coronary angiogram as well as percutaneous coronary intervention.

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Acknowledgements

All authors take responsibility for all aspects of the reliability and freedom from a bias of the data presented and their discussed interpretation. The authors thanks Toshio Ueda, who oversaw coronary CTA and analysis for CT-FFR.

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Authors and Affiliations

  1. Department of Cardiology Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, 120, Kurume, Tenjin-machi, 830-8577, Japan

    Ryota Fukuoka, Tomohiro Kawasaki, Kyoko Umeji & Nobuhiko Koga

  2. Department of Emergency, Shin-Koga Hospital, 120, Kurume, Tenjin-machi, 830-8577, Japan

    Taichi Okonogi

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  1. Ryota Fukuoka
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  2. Tomohiro Kawasaki
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Correspondence to Ryota Fukuoka.

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Fukuoka, R., Kawasaki, T., Umeji, K. et al. The diagnostic performance of on-site workstation-based computed tomography-derived fractional flow reserve. Comparison with myocardium perfusion imaging. Heart Vessels 37, 22–30 (2022). https://doi.org/10.1007/s00380-021-01897-w

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