Experience With an On-Site Coronary Computed Tomography-Derived Fractional Flow Reserve Algorithm for the Assessment of Intermediate Coronary Stenoses

Patrick M. Donnelly, Márton Kolossváry, Júlia Karády, Peter A. Ball, Stephanie Kelly, Donna Fitzsimons, Mark S. Spence, Csilla Celeng, Tamás Horváth, Bálint Szilveszter, Hendrik W. van Es, Martin J. Swaans, B. Merkely, Pál Maurovich-Horvat

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) is a new technique for the diagnosis of ischemic coronary artery stenoses. The aim of this prospective study was to evaluate the diagnostic performance of a novel on-site computed tomography-based fractional flow reserve algorithm (CT-FFR) compared with invasive FFR as the gold standard, and to determine whether its diagnostic performance is affected by interobserver variations in lumen segmentation. We enrolled 44 consecutive patients (64.6 ± 8.9 years, 34% female) with 60 coronary atherosclerotic lesions who underwent coronary CTA and invasive coronary angiography in 2 centers. An FFR value ≤0.8 was considered significant. Coronary CTA scans were evaluated by 2 expert readers, who manually adjusted the semiautomated coronary lumen segmentations for effective diameter stenosis (EDS) assessment and on-site CT-FFR simulation. The mean CT-FFR value was 0.77 ± 0.15, whereas the mean EDS was 43.6 ± 16.9%. The sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR versus EDS with a cutoff of 50% were the following: 91%, 72%, 63%, and 93% versus 52%, 87%, 69%, and 77%, respectively. The on-site CT-FFR demonstrated significantly better diagnostic performance compared with EDS (area under the curve 0.89 vs 0.74, respectively, p <0.001). The CT-FFR areas under the curve of the 2 readers did not show any significant difference (0.89 vs 0.88, p = 0.74). In conclusion, on-site CT-FFR simulation is feasible and has better diagnostic performance than anatomic stenosis assessment. Furthermore, the diagnostic performance of the on-site CT-FFR simulation algorithm does not depend on the readers’ semiautomated lumen segmentation adjustments.

Original languageEnglish
Pages (from-to)9-13
Number of pages5
JournalAmerican Journal of Cardiology
Volume121
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

Fingerprint

Coronary Stenosis
Tomography
Pathologic Constriction
Area Under Curve
Observer Variation
Coronary Angiography
Prospective Studies
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Experience With an On-Site Coronary Computed Tomography-Derived Fractional Flow Reserve Algorithm for the Assessment of Intermediate Coronary Stenoses. / Donnelly, Patrick M.; Kolossváry, Márton; Karády, Júlia; Ball, Peter A.; Kelly, Stephanie; Fitzsimons, Donna; Spence, Mark S.; Celeng, Csilla; Horváth, Tamás; Szilveszter, Bálint; van Es, Hendrik W.; Swaans, Martin J.; Merkely, B.; Maurovich-Horvat, Pál.

In: American Journal of Cardiology, Vol. 121, No. 1, 01.01.2018, p. 9-13.

Research output: Contribution to journalArticle

Donnelly, PM, Kolossváry, M, Karády, J, Ball, PA, Kelly, S, Fitzsimons, D, Spence, MS, Celeng, C, Horváth, T, Szilveszter, B, van Es, HW, Swaans, MJ, Merkely, B & Maurovich-Horvat, P 2018, 'Experience With an On-Site Coronary Computed Tomography-Derived Fractional Flow Reserve Algorithm for the Assessment of Intermediate Coronary Stenoses', American Journal of Cardiology, vol. 121, no. 1, pp. 9-13. https://doi.org/10.1016/j.amjcard.2017.09.018
Donnelly, Patrick M. ; Kolossváry, Márton ; Karády, Júlia ; Ball, Peter A. ; Kelly, Stephanie ; Fitzsimons, Donna ; Spence, Mark S. ; Celeng, Csilla ; Horváth, Tamás ; Szilveszter, Bálint ; van Es, Hendrik W. ; Swaans, Martin J. ; Merkely, B. ; Maurovich-Horvat, Pál. / Experience With an On-Site Coronary Computed Tomography-Derived Fractional Flow Reserve Algorithm for the Assessment of Intermediate Coronary Stenoses. In: American Journal of Cardiology. 2018 ; Vol. 121, No. 1. pp. 9-13.
@article{50efff2a862040208b58fe09da1fd03a,
title = "Experience With an On-Site Coronary Computed Tomography-Derived Fractional Flow Reserve Algorithm for the Assessment of Intermediate Coronary Stenoses",
abstract = "Fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) is a new technique for the diagnosis of ischemic coronary artery stenoses. The aim of this prospective study was to evaluate the diagnostic performance of a novel on-site computed tomography-based fractional flow reserve algorithm (CT-FFR) compared with invasive FFR as the gold standard, and to determine whether its diagnostic performance is affected by interobserver variations in lumen segmentation. We enrolled 44 consecutive patients (64.6 ± 8.9 years, 34{\%} female) with 60 coronary atherosclerotic lesions who underwent coronary CTA and invasive coronary angiography in 2 centers. An FFR value ≤0.8 was considered significant. Coronary CTA scans were evaluated by 2 expert readers, who manually adjusted the semiautomated coronary lumen segmentations for effective diameter stenosis (EDS) assessment and on-site CT-FFR simulation. The mean CT-FFR value was 0.77 ± 0.15, whereas the mean EDS was 43.6 ± 16.9{\%}. The sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR versus EDS with a cutoff of 50{\%} were the following: 91{\%}, 72{\%}, 63{\%}, and 93{\%} versus 52{\%}, 87{\%}, 69{\%}, and 77{\%}, respectively. The on-site CT-FFR demonstrated significantly better diagnostic performance compared with EDS (area under the curve 0.89 vs 0.74, respectively, p <0.001). The CT-FFR areas under the curve of the 2 readers did not show any significant difference (0.89 vs 0.88, p = 0.74). In conclusion, on-site CT-FFR simulation is feasible and has better diagnostic performance than anatomic stenosis assessment. Furthermore, the diagnostic performance of the on-site CT-FFR simulation algorithm does not depend on the readers’ semiautomated lumen segmentation adjustments.",
author = "Donnelly, {Patrick M.} and M{\'a}rton Kolossv{\'a}ry and J{\'u}lia Kar{\'a}dy and Ball, {Peter A.} and Stephanie Kelly and Donna Fitzsimons and Spence, {Mark S.} and Csilla Celeng and Tam{\'a}s Horv{\'a}th and B{\'a}lint Szilveszter and {van Es}, {Hendrik W.} and Swaans, {Martin J.} and B. Merkely and P{\'a}l Maurovich-Horvat",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.amjcard.2017.09.018",
language = "English",
volume = "121",
pages = "9--13",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Experience With an On-Site Coronary Computed Tomography-Derived Fractional Flow Reserve Algorithm for the Assessment of Intermediate Coronary Stenoses

AU - Donnelly, Patrick M.

AU - Kolossváry, Márton

AU - Karády, Júlia

AU - Ball, Peter A.

AU - Kelly, Stephanie

AU - Fitzsimons, Donna

AU - Spence, Mark S.

AU - Celeng, Csilla

AU - Horváth, Tamás

AU - Szilveszter, Bálint

AU - van Es, Hendrik W.

AU - Swaans, Martin J.

AU - Merkely, B.

AU - Maurovich-Horvat, Pál

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) is a new technique for the diagnosis of ischemic coronary artery stenoses. The aim of this prospective study was to evaluate the diagnostic performance of a novel on-site computed tomography-based fractional flow reserve algorithm (CT-FFR) compared with invasive FFR as the gold standard, and to determine whether its diagnostic performance is affected by interobserver variations in lumen segmentation. We enrolled 44 consecutive patients (64.6 ± 8.9 years, 34% female) with 60 coronary atherosclerotic lesions who underwent coronary CTA and invasive coronary angiography in 2 centers. An FFR value ≤0.8 was considered significant. Coronary CTA scans were evaluated by 2 expert readers, who manually adjusted the semiautomated coronary lumen segmentations for effective diameter stenosis (EDS) assessment and on-site CT-FFR simulation. The mean CT-FFR value was 0.77 ± 0.15, whereas the mean EDS was 43.6 ± 16.9%. The sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR versus EDS with a cutoff of 50% were the following: 91%, 72%, 63%, and 93% versus 52%, 87%, 69%, and 77%, respectively. The on-site CT-FFR demonstrated significantly better diagnostic performance compared with EDS (area under the curve 0.89 vs 0.74, respectively, p <0.001). The CT-FFR areas under the curve of the 2 readers did not show any significant difference (0.89 vs 0.88, p = 0.74). In conclusion, on-site CT-FFR simulation is feasible and has better diagnostic performance than anatomic stenosis assessment. Furthermore, the diagnostic performance of the on-site CT-FFR simulation algorithm does not depend on the readers’ semiautomated lumen segmentation adjustments.

AB - Fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) is a new technique for the diagnosis of ischemic coronary artery stenoses. The aim of this prospective study was to evaluate the diagnostic performance of a novel on-site computed tomography-based fractional flow reserve algorithm (CT-FFR) compared with invasive FFR as the gold standard, and to determine whether its diagnostic performance is affected by interobserver variations in lumen segmentation. We enrolled 44 consecutive patients (64.6 ± 8.9 years, 34% female) with 60 coronary atherosclerotic lesions who underwent coronary CTA and invasive coronary angiography in 2 centers. An FFR value ≤0.8 was considered significant. Coronary CTA scans were evaluated by 2 expert readers, who manually adjusted the semiautomated coronary lumen segmentations for effective diameter stenosis (EDS) assessment and on-site CT-FFR simulation. The mean CT-FFR value was 0.77 ± 0.15, whereas the mean EDS was 43.6 ± 16.9%. The sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR versus EDS with a cutoff of 50% were the following: 91%, 72%, 63%, and 93% versus 52%, 87%, 69%, and 77%, respectively. The on-site CT-FFR demonstrated significantly better diagnostic performance compared with EDS (area under the curve 0.89 vs 0.74, respectively, p <0.001). The CT-FFR areas under the curve of the 2 readers did not show any significant difference (0.89 vs 0.88, p = 0.74). In conclusion, on-site CT-FFR simulation is feasible and has better diagnostic performance than anatomic stenosis assessment. Furthermore, the diagnostic performance of the on-site CT-FFR simulation algorithm does not depend on the readers’ semiautomated lumen segmentation adjustments.

UR - http://www.scopus.com/inward/record.url?scp=85032960063&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032960063&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2017.09.018

DO - 10.1016/j.amjcard.2017.09.018

M3 - Article

C2 - 29103607

AN - SCOPUS:85032960063

VL - 121

SP - 9

EP - 13

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 1

ER -