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

Zhuang, Baiyan; Wang, Shuli; Zhao, Shihua; Lu, Minjie

doi:10.1007/s00330-019-06470-8

Cited by 78 publications

(40 citation statements)

References 57 publications

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“…This promising new diagnostic tool was demonstrated to be as effective in vessels with diameter of 2.3-2.7 mm as in larger arteries with diameter 3.0-3.6 mm [28]. Similar technology based on non-invasive fractional flow reserve derived from computed tomography (FFRCT) has been introduced, but no data regarding its accuracy depending on vessel diameter have been published [29].…”

Section: Functional Assessmentmentioning

confidence: 99%

Small vessel coronary artery disease: How small can we go with myocardial revascularization?

et al. 2021

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The issue of small coronary artery atherosclerosis represents an intriguing aspect of coronary artery disease, which is related with higher rates of peri-and post-procedural complications and impaired long-term outcome. This problem is further complicated by the unclear definition of small coronary vessel. Recent randomized controlled trials have provided new data on possible novel interventional treatment of small coronary vessels with drug-coated balloons instead of traditional new-generation drug-eluting stent implantation. Also, the conservative management represents a therapeutic option in light of the results of the recent ISCHEMIA trial. The current article provides an overview of the most appropriate definition, interventional management, and prognosis of small coronary artery atherosclerosis.

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Section: Functional Assessmentmentioning

confidence: 99%

Small vessel coronary artery disease: How small can we go with myocardial revascularization?

et al. 2021

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“…However, CCTA is limited in the ability to determine which patients might benefit most from revascularization, and may result in overtreatment [5,18,19]. CT-FFR has the ability to identify a specific coronary lesion that causes ischemia and opens the way to a treatment strategy at a coronary artery lesion-specific level without additional imaging [7]. In this study, we showed that, of the 372 patients who had been randomized to a tiered cardiac CT protocol, only 53 patients (14%) would have required CT-FFR analysis to decrease the need for additional testing from 19 to merely 11% (p < 0.001) in the entire study population.…”

Section: Diagnostic Efficiencymentioning

confidence: 99%

“…Because the anatomic stenosis severity is a weak predictor of hemodynamic significance, functional evaluation is recommended for therapeutic decision-making [3]. CT-derived fractional flow reserve (CT-FFR) can compute FFR values from standard CCTA images without requiring additional testing and radiation exposure, and has shown a good correlation and agreement with invasive FFR in several studies [4][5][6][7]. On-site CT-FFR software enables CT-FFR analyses on standard workstation without transferring CT images [8,9].…”

Section: Introductionmentioning

confidence: 99%

Impact of machine-learning CT-derived fractional flow reserve for the diagnosis and management of coronary artery disease in the randomized CRESCENT trials

et al. 2020

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Objective To determine the potential impact of on-site CT-derived fractional flow reserve (CT-FFR) on the diagnostic efficiency and effectiveness of coronary CT angiography (CCTA) in patients with obstructive coronary artery disease (CAD) on CCTA. Methods This observational cohort study included patients with suspected CAD who had been randomized to cardiac CT in the CRESCENT I and II trials. On-site CT-FFR was blindly performed in all patients with at least one ≥ 50% stenosis on CCTA and no exclusion criteria for CT-FFR. We retrospectively assessed the effect of adding CT-FFR to the CT protocol in patients with a stenosis ≥ 50% on CCTA in terms of diagnostic effectiveness, i.e., the number of additional tests required to determine the final diagnosis, reclassification of the initial management strategy, and invasive coronary angiography (ICA) efficiency, i.e., ICA rate without ≥ 50% CAD. Results Fifty-three patients out of the 372 patients (14%) had at least one ≥ 50% stenosis on CCTA of whom 42/53 patients (79%) had no exclusion criteria for CT-FFR. CT-FFR showed a hemodynamically significant stenosis (≤ 0.80) in 27/53 patients (51%). The availability of CT-FFR would have reduced the number of patients requiring additional testing by 57%-points compared with CCTA alone (37/53 vs. 7/53, p < 0.001). The initial management strategy would have changed for 30 patients (57%, p < 0.001). Reserving ICA for patients with a CT-FFR ≤ 0.80 would have reduced the number of ICA following CCTA by 13%-points (p = 0.016). Conclusion Implementation of on-site CT-FFR may change management and improve diagnostic efficiency and effectiveness in patients with obstructive CAD on CCTA. Key Points • The availability of on-site CT-FFR in the diagnostic evaluation of patients with obstructive CAD on CCTA would have significantly reduced the number of patients requiring additional testing compared with CCTA alone. • The implementation of on-site CT-FFR would have changed the initial management strategy significantly in the patients with obstructive CAD on CCTA. • Restricting ICA to patients with a positive CT-FFR would have significantly reduced the ICA rate in patients with obstructive CAD on CCTA.

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“…Weitere Analysealgorithmen für Ruhe-Indizes wurden entwickelt, die auf einem ähnlichen Prinzip basieren, aber vom iFR-Algorithmus etwas abweichen. Hierzu gehören ▪ die diastolischen Druckgradienten dPR ("diastolic pressure ratio") [4], teilweise als DFR ("diastolic hyperemia-free ratio") geschützt, sowie ▪ der als RFR ("resting full-cycle ratio") bezeichnete Algorithmus [18], der den maximalen Druckgradient Pd/Pa während des gesamten Herzzyklus identifiziert (ca. 12 % aller Messungen auch in der Systole, vor allem in der rechten Koronararterie [18]) (▶ Abb.…”

Section: Andere Ruhe-indizesunclassified

“…Die CT-Angiografie neigt dazu, den Grad einer Stenose und deren Relevanz eher zu überschätzen. Mit der CT-FFR kann die diagnostische Genauigkeit der CT-Angiografie verbessert werden [18].…”

Section: Klinische Ergebnisse Zur Ct-ffrunclassified

FFR, iwFR und nicht invasive CT-FFR

Schächinger¹,

Niethammer²

2020

Kardiologie up2date

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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

Cited by 78 publications

References 57 publications

Small vessel coronary artery disease: How small can we go with myocardial revascularization?

Small vessel coronary artery disease: How small can we go with myocardial revascularization?

Impact of machine-learning CT-derived fractional flow reserve for the diagnosis and management of coronary artery disease in the randomized CRESCENT trials

FFR, iwFR und nicht invasive CT-FFR

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