Coronary CT Angiography-derived Fractional Flow Reserve Testing in                     Patients with Stable Coronary Artery Disease: Recommendations on Interpretation                     and Reporting

Nørgaard, Bjarne Linde; Fairbairn, Timothy A.; Safian, Robert D.; Rabbat, Mark; Ko, Brian; Jensen, Jesper Møller; Nieman, Koen; Chinnaiyan, Kavitha M.; Sand, Niels Peter Rønnow; Matsuo, Hitoshi; Leipsic, Jonathon; Raff, Gilbert

doi:10.1148/ryct.2019190050

Cited by 85 publications

(72 citation statements)

References 43 publications

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“…Using the FFR CT algorithm, the most widespread standard developed by HeartFlow Inc. (Redwood City, Calif), recent studies have shown that 35–44% of patients with stable coronary artery disease and lowest FFR CT as positive were reclassified as negative when the FFR CT measurement point was 1-to-2 cm distal to a stenosis [17] , [18] . As a recent study also highlighted that the diagnostic performance of FFR ct measured at 1-to-2 cm distal to the stenosis was significantly higher than that of far-distal segments [19] , it is now recommended to measure FFR CT 1-to-2 cm distal to the end of a focal stenosis [20] . This is the first study, using the CT-FFR algorithm, which demonstrated the diagnostic performance of CT-FFR was significantly better when measured at 1-to-2 cm distal to a target stenosis than measured at the vessel terminus.…”

Section: Discussionmentioning

confidence: 99%

Comparison of diagnostic performance in on-site based CT-derived fractional flow reserve measurements

Nozaki

Fujimoto

Aoshima

et al. 2021

IJC Heart & Vasculature

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Background Computed tomography fractional flow reserve (CT-FFR), which can be acquired on-site workstation using fluid structure interaction during the multiple optimal diastolic phase, has an incremental diagnostic value over conventional coronary computed tomography angiography (CCTA). However, the appropriate location for CT-FFR measurement remains to be clarified. Method A total of 115 consecutive patients with 149 vessels who underwent CCTA showing 30–90% stenosis with invasive FFR within 90 days were retrospectively analyzed. CT-FFR values were measured at three points: 1 and 2 cm distal to the target lesion (CT-FFR 1cm, 2cm ) and the vessel terminus (CT-FFR lowest ). The diagnostic accuracies of CT-FFR ≤ 0.80 for detecting hemodynamically significant stenosis, defined as invasive FFR ≤ 0.80, were compered. Result Fifty-five vessels (36.9%) had invasive FFR ≤ 0.80. The accuracy and AUC for CT-FFR 1cm and 2cm were comparable, while the AUC for CT-FFR lowest was significantly lower than CT-FFR 1cm and 2cm . (lowest/1cm, 2 cm = 0.68 (95 %CI 0.63–0.73) vs 0.79 (0.72–0.86, p = 0.006), 0.80 (0.73–0.87, p = 0.002)) The sensitivity and negative predictive value of CT-FFR lowest were 100%. The reclassification rates from positive CT-FFR lowest to negative CT-FFR 1cm and 2cm were 55.7% and 54.2%, respectively. Conclusion The diagnostic performance of CT-FFR was comparable when measured at 1-to-2 cm distal to the target lesion, but significantly higher than CT-FFR lowest . The lesion-specific CT-FFR could reclassify false positive cases in patients with positive CT-FFR lowest , while all patients with negative CT-FFR lowest were diagnosed as negative by invasive FFR.

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Section: Discussionmentioning

confidence: 99%

Comparison of diagnostic performance in on-site based CT-derived fractional flow reserve measurements

Nozaki

Fujimoto

Aoshima

et al. 2021

IJC Heart & Vasculature

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“…Tools such as Sim-Vascular have been key in research on individualized medicine, surgical planning and medical device design [Updegrove et al, 2017]. Recently, CTA derived fractional flow reserve became the first and only simulation-based technology approved by the United States Food and Drug Administration for CAD diagnosis; this method is being implemented by HeartFlow Inc, in Redwood City, California [Nørgaard et al, 2019]. Other noninvasive methods based on machine learning and reduced order models have also been increasing in popularity [Douglas et al, 2015].…”

Section: Discussionmentioning

confidence: 99%

A Study of Coronary Artery Disease in the Left Circumflex Artery via Artificial Vessel Restoration

Paulraj

2020

Preprint

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In recent years, computational fluid dynamics techniques have been employed to advance the understanding of cardiovascular flows and have been largely focused on wall shear stress (WSS) and the effect of disturbed flows on atherosclerosis, and in turn, coronary artery disease (CAD). To gain further insight into the hemodynamics associated with CAD, numerical simulations were conducted on a diseased left circumflex artery (LCX). The vessel geometry was derived from computed tomography angiography (CTA) data of a diseased LCX vessel. The diseased vessel was then artificially restored to represent its initially healthy geometry, and simulations were re-run for comparison. It was determined that alongside the expected low WSS, a region of high vorticity was present at the location where CAD developed, resulting in disturbed blood flow. The vorticity may also be associated with the curvature of the vessel. The relevance of the observed characteristics was further supported by perturbing the geometry of the restored LCX via dilation to account for inaccuracies in the restoration process. This research suggests that vorticity is an important factor in assessing the risk for CAD, potentially improving the accuracy of non-invasive, computational diagnosis. In turn, as computational analysis of the coronary arteries improves, it is likely that unnecessary invasive diagnosis methods, such as an angiogram, can be avoided.

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“…A d-FFR CT -value ⩽0.75 was indicative of impaired flow. 26,27 Follow-up Electronic patient journals were used to register major adverse outcomes (all-cause mortality, myocardial infarction and stroke) at follow-up, 4 to 6 years after the initial coronary CTA.…”

Section: Ffr Ctmentioning

confidence: 99%

Coronary flow impairment in asymptomatic patients with early stage type-2 diabetes: Detection by FFR_CT

Mrgan

Nørgaard

Dey

et al. 2020

Diabetes and Vascular Disease Research

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Purpose: To determine the occurrence of physiological significant coronary artery disease (CAD) by coronary CT angiography (CTA) derived fractional flow reserve (FFRCT) in asymptomatic patients with a new diagnosis (<1 year) of type-2 diabetes mellitus (T2DM). Methods: FFRCT-analysis was performed from standard acquired coronary CTA data sets. The per-patient minimum distal FFRCT-value (d-FFRCT) in coronary vessels (diameter ⩾1.8 mm) was registered. The threshold for categorizing FFRCT-analysis as abnormal was a d-FFRCT ⩽0.75. Total plaque volume and volumes of calcified plaque, non-calcified plaque, and low-density non-calcified plaque (LD-NCP) were assessed by quantitative plaque analysis. Results: Overall, 76 patients; age, mean (SD): 56 (11) years; males, n (%): 49(65), were studied. A total of 57% of patients had plaques. The d-FFRCT was ⩽0.75 in 12 (16%) patients. The d-FFRCT, median (IQR), was 0.84 (0.79–0.87). Median (range) d-FFRCT in patients with d-FFRCT ⩽0.75 was 0.70 (0.6–0.74). Patients with d-FFRCT⩽0.75 versus d-FFRCT >0.75 had numerically higher plaque volumes for all plaques components, although only significant for the LD-NCP component. Conclusion: Every sixth asymptomatic patient with a new diagnosis of T2DM has hemodynamic significant CAD as evaluated by FFRCT. Flow impairment by FFRCT was associated with coronary plaque characteristics.

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Coronary CT Angiography-derived Fractional Flow Reserve Testing in Patients with Stable Coronary Artery Disease: Recommendations on Interpretation and Reporting

Cited by 85 publications

References 43 publications

Comparison of diagnostic performance in on-site based CT-derived fractional flow reserve measurements

Comparison of diagnostic performance in on-site based CT-derived fractional flow reserve measurements

A Study of Coronary Artery Disease in the Left Circumflex Artery via Artificial Vessel Restoration

Coronary flow impairment in asymptomatic patients with early stage type-2 diabetes: Detection by FFR_CT

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Coronary CT Angiography-derived Fractional Flow Reserve Testing in Patients with Stable Coronary Artery Disease: Recommendations on Interpretation and Reporting

Cited by 85 publications

References 43 publications

Comparison of diagnostic performance in on-site based CT-derived fractional flow reserve measurements

Comparison of diagnostic performance in on-site based CT-derived fractional flow reserve measurements

A Study of Coronary Artery Disease in the Left Circumflex Artery via Artificial Vessel Restoration

Coronary flow impairment in asymptomatic patients with early stage type-2 diabetes: Detection by FFRCT

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Coronary flow impairment in asymptomatic patients with early stage type-2 diabetes: Detection by FFR_CT