Diagnostic performance of transluminal attenuation gradient and fractional flow reserve by coronary computed tomographic angiography (FFRCT) compared to invasive FFR: a sub-group analysis from the DISCOVER-FLOW and DeFACTO studies

Abstract

Although coronary computed tomographic angiography (CCTA) has been a robust diagnostic tool to identify anatomical significance of coronary artery disease (CAD), the utility of CCTA to assess hemodynamic significance of CAD remains unclear. We investigated the diagnostic performance of transluminal attenuation gradient (TAG) and fractional flow reserve derived from CCTA (FFR CT ) to predict lesion-specific ischemia by invasive FFR. We identified 103 patients with suspected or known CAD enrolled from the DISCOVER-FLOW and DeFACTO studies who underwent invasive coronary angiography with FFR and high quality C64-slice CCTA. Diagnostic performance for predicting abnormal invasive FFR (B0.80) was assessed for TAG [B-1.1 HU/mm by the area under the curve (AUC) by receiver-operating characteristic curve analysis (ROC)], FFR CT (B0.80), and CCTA stenosis (C50 %). On a per-vessel analysis (n = 146), 52 vessels (35.6 %) had ischemia by invasive FFR. The sensitivity, specificity, positive predictive value and negative predictive value were 53.8, 45.7, 35.4, 64.2 % for TAG, 82.7, 74.5, 64.2, 88.6 % for FFR CT , 84.6, 39.4, 43.6, 82 . These results remained consistent regardless of the number of CCTA slices. FFR CT allows identification of lesion-specific ischemia using invasive FFR as a reference standard with greater diagnostic accuracy than TAG, CCTA stenosis, or the combination of the two.

Presence, Characteristics, and Volumes of Coronary Plaque Determined by Computed Tomography Angiography in Young Type 2 Diabetes Mellitus

“…Reproducibility for using the software has been reported previously. 15,16 Baseline characteristics of the study population were analyzed in the diabetic and nondiabetic population. All the categorical variables were calculated as frequency (percentage), and continuous data were presented as median (interquartile range) due to lack of normal distribution for most variables.…”

Bridging the Atlantic gap in clinical guidelines for non-ST-elevation acute coronary syndromes

“…9 Our goal of accurately characterizing each patient has however improved with perfusion CT and fractional flow reserve (FFR)-CT, despite this being often at odds with anatomic CT, as even anatomically significant lesions may be associated with normal FFR values. 10 This clearly reinforces the importance of the functional detail, despite the fact that FFR validity has been questioned in the acute phase of myocardial injury. Several other limitations to CT apply, including protocol issues, variability in interpretation, need for an expert reader, coronary calcium, prior stenting, heart rate, arrhythmias, and so forth.…”

Evaluation of Transluminal Attenuation Gradient in Computed Tomography in Intact Coronary Arteries

“…[7], не может быть использовано для разграничения функционально значимых стенозов от незначимых изменений. Считаем, что возможности ВГОК для выявления гемодинамических значимых стенотических изменений коронарных артерий ограничены, учитывая результаты нашей работы и других исследований [11,15,16,17]. Более перспективным в настоящее время является изучение возможностей использования ФРККТА для выявления функционально значимых стенотических изменений.…”