Prognostic value of the optimal measurement location of on-site CT-derived fractional flow reserve

Nozaki, Yui; Fujimoto, Shinichiro; Kawaguchi, Yuko; Aoshima, Chihiro; Kamo, Yuki; Sato, Hideyuki; Kudo, Hikaru; Takamura, Kazuhisa; Kudo, Ayako; Takahashi, Daigo; Hiki, Makoto; Dohi, Tomotaka; Tomizawa, Nobuo; Kumamaru, Kanako K.; Aoki, Shigeki; Minamino, Tohru

doi:10.1016/j.jjcc.2022.02.019

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…The C FFR was significantly higher at the maximum point of stenosis than distal to the stenosis. These results are in line with the studies by Nozaki Y. et al and Kueh S. et al, who showed that a C FFR measured 1–2 cm distal to a target stenosis is more consistent with the decision for revascularization than measured at the maximum point of the stenosis 34 35 .…”

Section: Discussionsupporting

confidence: 92%

On-site CT-derived cFFR in patients with suspected coronary artery disease: Feasibility on a 128-row CT scanner in everyday clinical practice

Baumeister,

Kloth,

Schmidt

et al. 2023

Rofo

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Purpose Technical feasibility of CT-based calculation of fractional flow reserve (cFFR) using a 128-row computed tomography scanner in an everyday routine setting. Post-processing and everyday practicability should be analyzed on the scanner on-site in connection with clinical parameters. Materials and Methods This single-center retrospective analysis included 230 patients (74 female; mean age 63.8 years) with CCTA within 21 months between 01/2018 and 09/2019 without non-pathological examinations. cFFR values were obtained using a deep learning-based non-commercial research prototype (cFFR Version3.5.0; Siemens Healthineers GmbH, Erlangen). cFFR values were evaluated at two points: at the maximum point of the stenosis and 1.0 cm distal to the stenosis. Comparison with invasive coronary angiography in 57/230 patients (24.7 %) was performed. CT parameters and quality were evaluated. Further subgroup classification concerning criteria of technical postprocessing was performed: no changes necessary, minor corrections necessary, major corrections necessary, and no evaluation was possible. The required time from starting the software to the final result was evaluated. Results A total of 116/448 (25.9 %) mild, 223/448 (49.8 %) moderate, and 109/448 (24.3 %) obstructive stenoses was found. The mean cFFR at the maximum point of the stenosis was 0.92 ± 0.09 and significantly higher than the cFRR value of 0.89 ± 0.13 distal to the stenosis (p < 0.001*). The mean degree of stenosis was 44.02 ± 26.99 % (range: 1–99 %) with an area of 5.39 ± 3.30 mm2. In a total of 45 patients (19.1 %), a relevant reduction in cFFR below 0.80 was determined. Overall, in 57/230 patients (24.8 %), catheter angiography was performed. No significant difference in the degree of maximal stenosis (CAD-RADS 0–2/3/4) was detected between the classification of CCTA and ICA (p = 0.171). The mean post-processing time varied significantly with 8.34 ± 4.66 min. in single-vessel CAD vs. 12.91 ± 3.92 min. in two-vessel CAD vs. 21.80 ± 5.94 min. in three-vessel CAD (each p < 0.001). Conclusion Noninvasive onsite quantification of cFFR is feasible with minimal observer interaction in a routine real-world setting on a 128-row scanner. Deep learning-based algorithms allow a robust and semi-automatic on-site determination of cFFR based on data from standard CT scanners. Key Points:

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Section: Discussionsupporting

confidence: 92%

On-site CT-derived cFFR in patients with suspected coronary artery disease: Feasibility on a 128-row CT scanner in everyday clinical practice

Baumeister,

Kloth,

Schmidt

et al. 2023

Rofo

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show abstract

“… 1 A study also demonstrated that greater ∆FFR CT is associated with an increase in cardiovascular events. 2 Our patient’s distal FFR CT and ∆FFR CT improved after lipid-lowering therapy, suggesting the usefulness of FFR CT for clinically assessing improvement in coronary ischemia with lipid-lowering therapy.…”

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confidence: 57%

Evaluation of Changes in Coronary Ischemia After Lipid-Lowering Therapy Using Computed Tomography Angiography

Nishihara,

Nakashima,

Ichikawa

et al. 2024

Circ Rep

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“…The details regarding the computation and how onsite processing was performed are provided in the online appendix. Lesion-specific CT-FFR value was measured 1–2 cm distal to the lesion for all coronary stenosis on major epicardial vessels with diameter ≥ 2 mm [ 28 ]. Vessel-specific CT-FFR was defined as the CT-FFR value for the most distal lesion.…”

Section: Methodsmentioning

confidence: 99%

CT-derived fractional flow reserve for prediction of major adverse cardiovascular events in diabetic patients

Lan

Ding

et al. 2023

Cardiovasc Diabetol

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Objectives To investigate the prognostic value of computed tomography fractional flow reserve (CT-FFR) in patients with diabetes and to establish a risk stratification model for major adverse cardiac event (MACE). Methods Diabetic patients with intermediate pre-test probability of coronary artery disease were prospectively enrolled. All patients were referred for coronary computed tomography angiography and followed up for at least 2 years. In the training cohort comprising of 957 patients, two models were developed: model1 with the inclusion of clinical and conventional imaging parameters, model2 incorporating the above parameters + CT-FFR. An internal validation cohort comprising 411 patients and an independent external test cohort of 429 patients were used to validate the proposed models. Results 1797 patients (mean age: 61.0 ± 7.0 years, 1031 males) were finally included in the present study. MACE occurred in 7.18% (129/1797) of the current cohort during follow- up. Multivariate Cox regression analysis revealed that CT-FFR ≤ 0.80 (hazard ratio [HR] = 4.534, p < 0.001), HbA1c (HR = 1.142, p = 0.015) and low attenuation plaque (LAP) (HR = 3.973, p = 0.041) were the independent predictors for MACE. In the training cohort, the Log-likelihood test showed statistical significance between model1 and model2 (p < 0.001). The C-index of model2 was significantly larger than that of model1 (C-index = 0.82 [0.77–0.87] vs. 0.80 [0.75–0.85], p = 0.021). Similar findings were found in internal validation and external test cohorts. Conclusion CT-FFR was a strong independent predictor for MACE in diabetic cohort. The model incorporating CT-FFR, LAP and HbA1c yielded excellent performance in predicting MACE.

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Prognostic value of the optimal measurement location of on-site CT-derived fractional flow reserve

Cited by 5 publications

References 29 publications

On-site CT-derived cFFR in patients with suspected coronary artery disease: Feasibility on a 128-row CT scanner in everyday clinical practice

On-site CT-derived cFFR in patients with suspected coronary artery disease: Feasibility on a 128-row CT scanner in everyday clinical practice

Evaluation of Changes in Coronary Ischemia After Lipid-Lowering Therapy Using Computed Tomography Angiography

CT-derived fractional flow reserve for prediction of major adverse cardiovascular events in diabetic patients

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