Prospective comparisons of three interpretation methods of fractional flow reserve derived from coronary computed tomography angiography

Kun Xu; Lin Yang; Jingyuan Zhang; Wenhao Huang; Yumeng Hu; Xiaochang Leng; Yajun Liu; Xiaowei Liu; Hongfeng Jin; Yiming Tang; Jiangting Wang; Yitao Guo; Chen Ye; Jianjun Zhang; Jianping Xiang; Lijiang Tang; Changqing Du

doi:10.21037/qims-24-600

Prospective comparisons of three interpretation methods of fractional flow reserve derived from coronary computed tomography angiography

Quant Imaging Med Surg. 2025 Mar 3;15(3):2146-2161. doi: 10.21037/qims-24-600. Epub 2025 Feb 26.

Authors

Kun Xu^#¹, Lin Yang^#², Jingyuan Zhang^#³, Wenhao Huang⁴, Yumeng Hu⁵, Xiaochang Leng⁵, Yajun Liu⁴, Xiaowei Liu⁶, Hongfeng Jin⁶, Yiming Tang⁶, Jiangting Wang⁶, Yitao Guo⁶, Chen Ye⁶, Jianjun Zhang⁷, Jianping Xiang⁵, Lijiang Tang⁶, Changqing Du⁶

Affiliations

¹ Department of Internal Medicine, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou, China.
² Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
³ Department of Cardiology, Huaibei Miners Hospital, Huaibei, China.
⁴ Department of Medicine, The Second College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
⁵ ArteryFlow Technology Co., Ltd., Hangzhou, China.
⁶ Department of Cardiology, Zhejiang Hospital, Hangzhou, China.
⁷ Department of Radiology, Zhejiang Hospital, Hangzhou, China.

^# Contributed equally.

Abstract

Background: The selection of fractional flow reserve derived from computed tomography (CT-FFR) calculation locations is of particular importance when determining ischemic lesions for guiding therapeutic strategies. However, to date, there has been no prospective research comparing different measured locations of CT-FFR. The study aimed to prospectively compare the diagnostic efficiency of three interpretation methods of CT-FFR, using invasive fractional flow reserve (FFR) as the reference standard.

Methods: Patients with stable coronary heart disease (CHD) who underwent coronary computed tomography angiography (CCTA) examination and met the inclusion criteria at Zhejiang Hospital from January 2019 to June 2021 were prospectively enrolled. All patients underwent invasive coronary angiography and FFR within 60 days after the CCTA examination. The CT-FFR values were computed using the novel computational fluid dynamics (CFD)-based model, AccuFFRct. Diagnostic performance of vessel-level CT-FFR, lesion-specific CT-FFR, and ΔCT-FFR were evaluated with invasive FFR ≤0.8 as the reference standard and multivariate logistic regression was used to further analyze the influencing factors of their inconsistency with FFR.

Results: In total, 124 patients with 143 vessels were included in this prospective study. On a per-vessel basis, vessel-level AccuFFRct and lesion-specific AccuFFRct had good correlation with invasive FFR (r=0.70 and r=0.66, respectively). With invasive FFR ≤0.8 as the reference standard for the diagnosis of myocardial ischemia, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and area under the curve (AUC) values of CCTA, vessel-level AccuFFRct, lesion-specific AccuFFRct, and ΔAccuFFRct in the diagnosis of myocardial ischemia were 82.0%, 40.2%, 50.5%, 75.0%, 58.0%, 0.611; 93.4%, 89.0%, 86.4%, 94.8%, 90.9%, 0.937; 62.3%, 92.7%, 86.4%, 76.8%, 79.7%, 0.880 and 62.3%, 92.7%, 86.4%, 76.8%, 79.7%, and 0.854, respectively.

Conclusions: Vessel-level AccuFFRct, lesion-specific AccuFFRct, and ΔAccuFFRct provided better diagnostic performance compared with CCTA, with vessel-level AccuFFRct being superior in predicting myocardial ischemia, whereas lesion-specific AccuFFRct and ΔAccuFFRct had higher specificity than vessel-level AccuFFRct.

Keywords: Coronary heart disease (CHD); computational fluid dynamics (CFD); coronary computed tomography angiography (CCTA); fractional flow reserve (FFR); myocardial ischemia.