Carlos Collet1,2, Yoshinobu Onuma3,4, Jeroen Sonck2, Taku Asano1, Bert Vandeloo2, Ran Kornowski5, Shengxian Tu6, Jelmer Westra7, Niels R Holm7, Bo Xu8, Robbert J de Winter1, Jan G Tijssen1, Yosuke Miyazaki4, Yuki Katagiri1, Erhan Tenekecioglu4, Rodrigo Modolo1, Ply Chichareon1, Bernard Cosyns2, Daniel Schoors2, Bram Roosens2, Stijn Lochy2, Jean-Francois Argacha2, Alexandre van Rosendael9, Jeroen Bax9, Johan H C Reiber10,11, Javier Escaned12, Bernard De Bruyne13, William Wijns14, Patrick W Serruys15. 1. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. 2. Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium. 3. Cardialysis BV, Rotterdam, The Netherlands. 4. Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. 5. Cardiology Department, Rabin Medical Center, Belinson Hospital Affiliated to the "Sackler" Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel. 6. Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. 7. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. 8. Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China. 9. Department of Cardiology, Leiden University Medical Center, The Netherlands. 10. Division of Image Processing (LKEB), Department of Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands. 11. Medis Medical Imaging Systems, Leiden, The Netherlands. 12. Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain. 13. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium. 14. The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Saolta University Healthcare Group, Galway, Ireland. 15. Department of Cardiology, Imperial College London, London, UK.
Abstract
Aims: Pressure-wire assessment of coronary stenosis is considered the invasive reference standard for detection of ischaemia-generating lesions. Recently, methods to estimate the fractional flow reserve (FFR) from conventional angiography without the use of a pressure wire have been developed, and were shown to have an excellent diagnostic accuracy. The present systematic review and meta-analysis aimed at determining the diagnostic performance of angiography-derived FFR for the diagnosis of haemodynamically significant coronary artery disease. Methods and results: A systematic review and meta-analysis of studies assessing the diagnostic performance of angiography-derived FFR systems were performed. The primary outcome of interest was pooled sensitivity and specificity. Thirteen studies comprising 1842 vessels were included in the final analysis. A Bayesian bivariate meta-analysis yielded a pooled sensitivity of 89% (95% credible interval 83-94%), specificity of 90% (95% credible interval 88-92%), positive likelihood ratio (+LR) of 9.3 (95% credible interval 7.3-11.7) and negative likelihood ratio (-LR) of 0.13 (95% credible interval 0.07-0.2). The summary area under the receiver-operating curve was 0.84 (95% credible interval 0.66-0.94). Meta-regression analysis did not find differences between the methods for pressure-drop calculation (computational fluid dynamics vs. mathematical formula), type of analysis (on-line vs. off-line) or software packages. Conclusion: The accuracy of angiography-derived FFR was good to detect haemodynamically significant lesions with pressure-wire measured FFR as a reference. Computational approaches and software packages did not influence the diagnostic accuracy of angiography-derived FFR. A diagnostic strategy trial with angiography-derived FFR evaluating clinical endpoints is warranted.
Aims: Pressure-wire assessment of coronary stenosis is considered the invasive reference standard for detection of ischaemia-generating lesions. Recently, methods to estimate the fractional flow reserve (FFR) from conventional angiography without the use of a pressure wire have been developed, and were shown to have an excellent diagnostic accuracy. The present systematic review and meta-analysis aimed at determining the diagnostic performance of angiography-derived FFR for the diagnosis of haemodynamically significant coronary artery disease. Methods and results: A systematic review and meta-analysis of studies assessing the diagnostic performance of angiography-derived FFR systems were performed. The primary outcome of interest was pooled sensitivity and specificity. Thirteen studies comprising 1842 vessels were included in the final analysis. A Bayesian bivariate meta-analysis yielded a pooled sensitivity of 89% (95% credible interval 83-94%), specificity of 90% (95% credible interval 88-92%), positive likelihood ratio (+LR) of 9.3 (95% credible interval 7.3-11.7) and negative likelihood ratio (-LR) of 0.13 (95% credible interval 0.07-0.2). The summary area under the receiver-operating curve was 0.84 (95% credible interval 0.66-0.94). Meta-regression analysis did not find differences between the methods for pressure-drop calculation (computational fluid dynamics vs. mathematical formula), type of analysis (on-line vs. off-line) or software packages. Conclusion: The accuracy of angiography-derived FFR was good to detect haemodynamically significant lesions with pressure-wire measured FFR as a reference. Computational approaches and software packages did not influence the diagnostic accuracy of angiography-derived FFR. A diagnostic strategy trial with angiography-derived FFR evaluating clinical endpoints is warranted.
Authors: Balázs Tar; Csaba Jenei; Áron Üveges; Gábor Tamás Szabó; András Ágoston; Csaba András Dézsi; András Komócsi; Dániel Czuriga; Attila Juhász; Zsolt Kőszegi Journal: Cardiol J Date: 2020-11-03 Impact factor: 2.737
Authors: Hans R Figulla; Alexander Lauten; Lars S Maier; Udo Sechtem; Sigmund Silber; Holger Thiele Journal: Dtsch Arztebl Int Date: 2020-02-28 Impact factor: 5.594
Authors: Katherine Lal; Rebecca Gosling; Mina Ghobrial; Gareth J Williams; Vignesh Rammohan; D Rod Hose; Patricia V Lawford; Andrew Narracott; John Fenner; Julian P Gunn; Paul D Morris Journal: Eur Heart J Digit Health Date: 2021-02-05