Abstract 17208: Diagnostic Performance of Novel CT-Fractional Flow Reserve Based on Structural and Fluid Analysis Using 4D-CT Image
Introduction: Recently, a method to calculate fractional flow reserve (FFR) by applying the principle of computational fluid dynamics based on coronary CT angiography (CCTA), and the its clinical usefulness has been reported. However, as for the diagnostic ability, compared to the sensitivity, especially, its specificity is said to have a variation. Using structural and fluid analysis and taking changes in coronary shape, movement, cross sectional area and cubic volume in multiple cardiac phases into consideration, an algorism of CT-FFR analysis which enables to set boundary conditions which are specific for individual patients has been developed. However, data about its clinical usefulness hardly have been reported. In this study, we evaluated the diagnostic performance of CT-FFR using the new algorism as a reference of invasive FFR.
Methods: The subjects were consecutive 22 cases with 26 vessels in which stenosis of 30-90% was detected at one vessel of at least 2mm or more in the major epicardial vessels and invasive FFR was performed within subsequent 90 days, among suspected cases of coronary arterial diseases which underwent one-rotation scanning by 320-row coronary CT. Prospective CCTA mode was used for all patients, with a range of X-ray exposure of 70-99% of the RR interval. Using the new algorism, FFR was calculated on-site from the multiple cardiac phases in the subject cases. The diagnostic accuracy of CT-FFR for functional stenosis defined as invasive FFR≦0.8 was evaluated by the sensitivity, specificity, and area under the receiving operating curve (AUC).
Results: Twelve vessels (46.2%) had an invasive FFR≦0.8. The sensitivity, specificity, positive predict value and negative predict value of CT-FFR vs CCTA≧50% to detect functional stenosis defined as FFR≦0.8 were 92% vs 83%, 71% vs 29%, 73% vs 50% and 91% vs 67% respectively. The AUC of CT-FFR was significantly higher than CCTA≧50% (0.82 vs 0.56 p<0.05). Correlation coefficient of reproducibility was 0.825.
Conclusions: Novel CT-FFR based on structural and fluid analysis has excellent diagnostic accuracy to detect a significant FFR≦0.8 compared to conventional CCTA. This novel technique could allow us to perform as an on-site with high reproducibility and short time to clinical practice.
Author Disclosures: Y. Kawaguchi: None. S. Fujimoto: None. K. Kumamaru: None. T. Dohi: None. K. Ri: None. K. Takamura: None. E. Kato: None. Y. Kato: None. H. Tamura: None. S. Okazaki: None. K. Isoda: None. H. Daida: Research Grant; Significant; Toshiba Medical Systems.
- © 2016 by American Heart Association, Inc.