Fractional Flow Reserve Derived From Computed Tomographic Angiography in Patients With Multivessel CAD

Abstract

Calculation of the noninvasive FSS is feasible and yielded similar results to those obtained with invasive pressure-wire assessment. The agreement on the SYNTAX score tertile classification improved with the inclusion of the functional component from slight to fair agreement. FFR has good accuracy in detecting functionally significant lesions in patients with 3-vessel CAD. (A Trial to Evaluate a New Strategy in the Functional Assessment of 3-Vessel Disease Using SYNTAX II Score in Patients Treated With PCI; NCT02015832).

Planning percutaneous coronary interventions using computed tomography angiography and fractional flow reserve‐derived from computed tomography: A state‐of‐the‐art review

“…While not yet incorporated into worldwide societal guidelines, a natural evolution of our understanding of CTA and FFRCT is to apply these noninvasive tools to decision‐making in high‐risk patients with multivessel and/or left main CAD , potentially without invasive angiography. As is true with invasive angiography and FFRINV, risk scores incorporating anatomic and physiologic variables can be created using CTA and FFRCT (anatomic and functional SYNTAX scores) . In fact, a recent editorial suggested that the era of performing ICA for patients with symptoms and an abnormal stress test may be coming to an end; we may be on the verge of a significant paradigm shift in which CAD is characterized noninvasively by CTA and FFRct .…”

FFRCT for Complex Coronary Artery Disease Treatment Planning: New Opportunities

“…Interestingly, the authors found that there was poor correlation between the invasive and non-invasive anatomical syntax but much better correlation between the non-invasive and invasive functional syntax score. 13 The anatomical SYNTAX score was overestimated by CTA compared with conventional angiography (27.6 ± 6.4 versus 25.3 ± 6.9; p<0.0001)…”

Koronare CT-Angiografie (CTA): Die anatomische Bildgebung überzeugt

“…Im Rahmen der SYNTAX-II-Studie (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) wurde die CTA-Diagnostik genutzt, um einen nicht invasiven funktionellen SYNTAX-Score zu erstellen [19]. Bei 77 Patienten mit koronarer Dreigefäßerkrankung erfolgte zunächst die Einteilung anhand der rein anatomischen CT-Bildgebung.…”

“…Der anatomische CTA-basierte SYNTAX-Score überschätzte den invasiven SYNTAX-Score, während der nicht invasive funktionelle CTA-/FFR CT -Score vergleichbare Ergebnisse wie der invasive SYNTAX-Score unter Berücksichtigung von FFR/ iFR ergab. Insgesamt zeigte die Kombination von CTA und daraus abgeleiteter FFR CT im Vergleich mit den invasiven Messungen eine sehr gute Übereinstimmung [19].…”