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
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.
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.
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).
FFRCT obtained a high diagnostic performance and is a viable alternative to FFR for detecting coronary ischemic lesions.
• 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.
KeywordsHemodynamics Computed tomography angiography Myocardial ischemia Stenosis Coronary artery disease
Area under the SROC
Coronary artery disease
Coronary computed tomography angiography
Cardiovascular magnetic resonance
Computed tomography perfusion
Fractional flow reserve
Computed tomography angiography-derived fractional flow reserve
Invasive coronary angiography
Negative likelihood ratio
Positive likelihood ratio
Negative predictive value
Positive predictive value
Single-photon emission computed tomography
Summary receiver operating characteristic curve
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
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.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• multicenter study
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