Abstract
Background
The aim of this study was to evaluate the diagnostic performance of coronary CT angiography
(CTA)-based quantitative flow ratio (QFR), namely CT-QFR, and compare it with invasive
coronary angiography (ICA)-based Murray law QFR (μQFR), using fractional flow reserve
(FFR) as the reference standard.
Methods
Patients who underwent coronary CTA, ICA and pressure wire-based FFR assessment within
two months were retrospectively analyzed. CT-QFR and μQFR were computed in blinded
fashion and compared with FFR, all applying the same cut-off value of ≤0.80 to identify
hemodynamically significant stenosis.
Results
Paired comparison between CT-QFR and μQFR was performed in 191 vessels from 167 patients.
Average FFR was 0.81 ± 0.10 and 42.4% vessels had an FFR ≤0.80. CT-QFR had a slightly
lower correlation with FFR compared with μQFR, although statistically non-significant
(r = 0.87 versus 0.90, p = 0.110). The vessel-level diagnostic performance of
CT-QFR was slightly lower but without statistical significance than μQFR (AUC = 0.94
versus 0.97, difference: −0.03 [95%CI: −0.00-0.06], p = 0.095), and substantially
higher than diameter stenosis by CTA (AUC difference: 0.17 [95%CI: −0.10-0.23], p < 0.001).
The patient-level diagnostic accuracy, sensitivity, specificity, positive predictive
value, negative predictive value, positive likelihood ratio and negative likelihood
ratio for CT-QFR to identify FFR value ≤ 0.80 was 88%, 90%, 86%, 86%, 91%, 6.59
and 0.12, respectively. The diagnostic accuracy of CT-QFR was 84% in extensively calcified
lesions, while in vessels with no or less calcification, CT-QFR showed a comparable
diagnostic accuracy with μQFR (91% versus 92%, p = 0.595). Intra- and inter-observer
variability in CT-QFR analysis was −0.00 ± 0.04 and 0.00 ± 0.04, respectively.
Conclusions
Performance in diagnosis of hemodynamically significant coronary stenosis by CT-QFR
was slightly lower but without statistical significance than μQFR, and substantially
higher than CTA-derived diameter stenosis. Extensively calcified lesions reduced the
diagnostic accuracy of CT-QFR.
Keywords
Abbreviations:
CABG (coronary artery bypass grafting), CAD (coronary artery disease), CFD (computational fluid dynamics), CTA (CT angiography), CT-QFR (CTA-derived quantitative flow ratio), DS% (percent diameter stenosis), FFR (fractional flow reserve), FFRct (CT-derived fractional flow reserve), ICA (invasive coronary angiography), LAD (left anterior descending artery), PCI (percutaneous coronary intervention), QFR (quantitative flow ratio), μQFR (invasive coronary angiography-based Murray law QFR)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 29, 2022
Accepted:
June 20,
2022
Received in revised form:
April 23,
2022
Received:
January 2,
2022
Identification
Copyright
© 2022 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
