BACKGROUND: Fractional flow reserve calculated from coronary CT (FFR(CT)) is a novel method for determining lesion-specific ischemia. OBJECTIVE: To assess the effect of CT quality on accuracy of FFR(CT), we compared performance of FFR(CT) with severe stenosis by CT in relation to image quality; heart rate; signal-to-noise ratio (SNR); and common CT artifacts, including calcification, motion, and poor contrast enhancement. METHODS: FFR(CT) was performed on 159 vessels in 103 patients undergoing CT, FFR(CT), and FFR. Ischemia was defined as FFR(CT) and FFR ≤ 0.80, and severe stenosis by CT was defined by ≥50% reduction in luminal diameter. FFR(CT) and CT stenosis were compared with FFR, which served as the reference. RESULTS: On a vessel basis, accuracy of FFR(CT) was higher than CT stenosis for satisfactory or poor quality CTs (87.5% vs 64.6%), for heart rates > 65 beats/min (100% vs 52.9%), and for SNR less than the median (26.3) (84.4% vs 64.1%). Accuracy of FFR(CT) was superior to CT stenosis in the presence of calcification (85.7% vs 66.7%), motion (90.5% vs 57.1%), and poor contrast opacification (100.0% vs 71.4%). Similar relations were observed for exploratory analyses of FFR(CT) and CT stenosis on a patient basis. In 42 subjects who underwent coronary calcium scanning, accuracy of FFR(CT) was 77.8% (n = 18), 100% (n = 11), and 100% (n = 13) for coronary calcium scores of 0-100, 101-400, and >400, respectively. CONCLUSIONS: Accuracy of FFR(CT) is superior to CT stenosis for determining lesion-specific ischemia. The performance of FFR(CT) remains robust across an array of factors known to adversely affect CT quality.
BACKGROUND: Fractional flow reserve calculated from coronary CT (FFR(CT)) is a novel method for determining lesion-specific ischemia. OBJECTIVE: To assess the effect of CT quality on accuracy of FFR(CT), we compared performance of FFR(CT) with severe stenosis by CT in relation to image quality; heart rate; signal-to-noise ratio (SNR); and common CT artifacts, including calcification, motion, and poor contrast enhancement. METHODS: FFR(CT) was performed on 159 vessels in 103 patients undergoing CT, FFR(CT), and FFR. Ischemia was defined as FFR(CT) and FFR ≤ 0.80, and severe stenosis by CT was defined by ≥50% reduction in luminal diameter. FFR(CT) and CT stenosis were compared with FFR, which served as the reference. RESULTS: On a vessel basis, accuracy of FFR(CT) was higher than CT stenosis for satisfactory or poor quality CTs (87.5% vs 64.6%), for heart rates > 65 beats/min (100% vs 52.9%), and for SNR less than the median (26.3) (84.4% vs 64.1%). Accuracy of FFR(CT) was superior to CT stenosis in the presence of calcification (85.7% vs 66.7%), motion (90.5% vs 57.1%), and poor contrast opacification (100.0% vs 71.4%). Similar relations were observed for exploratory analyses of FFR(CT) and CT stenosis on a patient basis. In 42 subjects who underwent coronary calcium scanning, accuracy of FFR(CT) was 77.8% (n = 18), 100% (n = 11), and 100% (n = 13) for coronary calcium scores of 0-100, 101-400, and >400, respectively. CONCLUSIONS: Accuracy of FFR(CT) is superior to CT stenosis for determining lesion-specific ischemia. The performance of FFR(CT) remains robust across an array of factors known to adversely affect CT quality.
Authors: Ryo Nakazato; Hyung-Bok Park; Daniel S Berman; Heidi Gransar; Bon-Kwon Koo; Andrejs Erglis; Fay Y Lin; Allison M Dunning; Matthew J Budoff; Jennifer Malpeso; Jonathon Leipsic; James K Min Journal: Circ Cardiovasc Imaging Date: 2014-05 Impact factor: 7.792
Authors: René R Sevag Packard; Dong Li; Matthew J Budoff; Ronald P Karlsberg Journal: Eur Heart J Cardiovasc Imaging Date: 2016-07-28 Impact factor: 6.875