Prospective Comparison of FFR Derived From Coronary CT Angiography With SPECT Perfusion Imaging in Stable Coronary Artery Disease

Abstract

In patients with stable chest pain and CAD as determined by coronary CTA, the overall diagnostic accuracy levels of FFR and SPECT were identical in assessing hemodynamically significant stenosis. However, FFR demonstrated a significantly higher diagnostic sensitivity than SPECT.

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

“…There is high per-patient and per-vessel agreement between FFR CT and invasive FFR using the threshold of 0.80 for both techniques (1,(15)(16)(17)(18). An FFR CT value greater than 0.80 indicates that the lesion is unlikely to be hemodynamically Abbreviations CAD = coronary artery disease, FFR = fractional flow reserve, FFR CT = CT angiography-derived FFR, LAD = left anterior descending artery, SCCT = Society of Cardiovascular Computed Tomography Summary Expert opinion and recommendation was given by an independent group of physicians on a standardized interpretation and reporting approach for CT-derived fractional flow reserve testing supported by years of clinical experience.…”

“…Accordingly, in vessels that have been assessed using both techniques, if the measurement locations of invasive FFR and FFR CT are not matched, their values can be different and may not closely correlate. significant and that the patient can be safely treated with optimal medical treatment without further downstream testing (1,(12)(13)(14)(15)(16)(17)(18)22,23). A poststenotic FFR CT value less than or equal to 0.80 indicates the possibility of hemodynamic significance (1,(15)(16)(17)(18).…”

“…significant and that the patient can be safely treated with optimal medical treatment without further downstream testing (1,(12)(13)(14)(15)(16)(17)(18)22,23). A poststenotic FFR CT value less than or equal to 0.80 indicates the possibility of hemodynamic significance (1,(15)(16)(17)(18). The use of this dichotomous FFR CT threshold to guide treatment decisions, namely to avoid further downstream testing or consider invasive angiography and revascularization, remains controversial, as it is well known from the invasive literature that the greatest benefit of revascularization is obtained in patients with the most severe pressure loss (24,25).…”

“…FFR CT assessment is increasingly used in mainstream clinical practice (9)(10)(11)(12)(13)(14) and is likely to further expand with the increased utilization of coronary CT angiography as a first-line test in patients suspected of having coronary artery disease (CAD). While there has been much focus on the diagnostic performance and potential clinical utility of FFR CT in patients with moderate CAD (9)(10)(11)(12)(13)(14)(15)(16)(17)(18), there has been less focus on interpretation, reporting, and integration of FFR CT results into routine clinical practice (19). A broadly adopted standardized FFR CT interpretation and reporting approach providing rich and consistent information may facilitate more appropriate clinical implementation and stimulate further high-quality research.…”

Clinical Impact of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Japanese Population in the ADVANCE Registry

“…In fact, only two-thirds of the patients to whom revascularization was exposure. [25][26][27] FFRCT may provide advantages in each of these areas, because of its accuracy 6-8 and elimination of additional visits and radiation exposure. Our analysis demonstrated that the proportion of patients deemed to require additional testing in Japan, at nearly 45% following the initial assessment by cCTA, was reduced to nearly zero (0.02%) after FFRCT analysis.…”