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Computed tomography angiography-derived fractional flow reserve (CT-FFR) for the detection of myocardial ischemia with invasive fractional flow reserve as reference: systematic review and meta-analysis

  • Baiyan Zhuang
  • Shuli Wang
  • Shihua ZhaoEmail author
  • Minjie LuEmail author
Cardiac

Abstract

Objectives

A method named computed tomography angiography-derived fractional flow reserve (FFRCT) is an alternative method for detecting hemodynamically significant coronary stenosis. We carried out a meta-analysis to derive reliable assessment of the diagnostic performances of FFRCT and compare the diagnostic accuracy with CCTA using FFR as reference.

Methods

We searched PubMed, EMBASE, The Cochrane Library, and Web of science for relevant articles published from January 2008 until May 2019 using the following search terms: FFRCT, noninvasive FFR, non-invasive FFR, noninvasive fractional flow reserve, non-invasive fractional flow reserve, and CCTA. Pooled estimates of sensitivity and specificity with the corresponding 95% confidence intervals (CIs) and the summary receiver operating characteristic curve (sROC) were determined.

Results

Sixteen studies published between 2011 and 2019 were included with a total of 1852 patients and 2731 vessels. The pooled sensitivity and specificity for FFRCT at the per-patient level was 89% (95% CI, 85–92%) and 71% (95% CI, 61–80%), respectively, while on the per-vessel basis was 85% (95% CI, 82–88%) and 82% (95% CI, 75–87%), respectively. No apparent difference in the sensitivity at per-patient and per-vessel level between FFRCT and CCTA was observed (0.89 versus 0.93 at per-patient; 0.85 versus 0.88 at per-vessel). However, the specificity of FFRCT was higher than CCTA (0.71 versus 0.32 at per-patient analysis; 0.82 versus 0.46 at per-vessel analysis).

Conclusions

FFRCT obtained a high diagnostic performance and is a viable alternative to FFR for detecting coronary ischemic lesions.

Key Points

Noninvasive FFRCThas higher specificity for anatomical and physiological assessment of coronary artery stenosis compared with CCTA.

Noninvasive FFRCTis a viable alternative to invasive FFR for the detection and exclusion of coronary lesions that cause ischemia.

Keywords

Hemodynamics Computed tomography angiography Myocardial ischemia Stenosis Coronary artery disease 

Abbreviations

AUC

Area under the SROC

CAD

Coronary artery disease

CCTA

Coronary computed tomography angiography

CIs

Confidence intervals

CMR

Cardiovascular magnetic resonance

CTP

Computed tomography perfusion

FFR

Fractional flow reserve

FFRCT

Computed tomography angiography-derived fractional flow reserve

FN

False negative

FP

False positive

I2

Inconsistency index

ICA

Invasive coronary angiography

LR−

Negative likelihood ratio

LR+

Positive likelihood ratio

NPV

Negative predictive value

PPV

Positive predictive value

SPECT

Single-photon emission computed tomography

SROC

Summary receiver operating characteristic curve

TN

True negative

TP

True positive

Notes

Funding information

This study has received funding by Research Grant of National Natural Science Foundation of China (81571647, 81971588, 81620108015, 81771811), and Capital Clinical Special Program (Z191100006619021).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Minjie Lu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• multicenter study

Supplementary material

330_2019_6470_MOESM1_ESM.docx (1.7 mb)
ESM 1 (DOCX 1747 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

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