Abstract 14788: Diagnostic Value of Fractional Flow Reserve Derived From Coronary Computed Tomographic Angiography by Hypertension or Smoking
Introduction: A recent novel technique allows non-invasively to identify the lesion-specific ischemia by fractional flow reserve (FFR) derived from coronary computed tomographic angiography (CTA) (FFRCT) and calculated by computational combined models of anatomy, physiology, and fluid dynamics. However, its diagnostic value for subjects with or without hypertension or smoking associated with microvascular resistance has not been examined.
Hypothesis: The aim of this study is to determine whether FFRCT predicts lesion-specific ischemia by invasive FFR among patients with or without hypertension or smoking.
Methods: We identified 103 patients with suspected or known coronary artery disease enrolled from the DISCOVER-FLOW and DeFACTO prospective blinded studies who underwent invasive coronary angiography (ICA) with FFR and ≥64 slice coronary CTA. All patients had nitroglycerin before coronary CTA studies. FFRCT was derived from coronary CTA using the latest-generation computational fluid dynamic techniques (HeartFlow). Diagnostic value of FFRCT (≤0.80) and CTA stenosis (≥50% by the core labs) for predicting ischemia by invasive FFR (≤0.80) was assessed among patients with or without hypertension or smoking.
Results: Out of 144 vessels, 52 vessels (36.1%) had lesion-specific ischemia by invasive FFR. On a per-vessel analysis, diagnostic accuracy of FFRCT was superior to that of CTA stenosis among patients with or without hypertension or smoking. The area under the curves (AUC) by receiver-operating characteristic curve analysis for FFRCT demonstrated significantly greater diagnostic performance for predicting ischemia compared to CTA stenosis regardless of the presence or absence of these risk factors (p<0.05 for each group) (Table).
Conclusions: Among patients with or without hypertension or smoking, FFRCT is a more reliable assessment for predicting lesion-specific ischemia by invasive FFR compared to CTA stenosis alone.
Author Disclosures: R. Nakanishi: None. D. Li: None. V. Bhatia: None. S. Sengputa: None. S. Matsumoto: None. A. Alani: None. B. Koo: None. J.K. Min: None. C. Dailing: None. M.J. Budoff: None.
- © 2014 by American Heart Association, Inc.