Stefan Baumann1,2,3, Markus Hirt4,5, U Joseph Schoepf6, Marlon Rutsch4,5, Christian Tesche7, Matthias Renker8, Joseph W Golden6, Sebastian J Buss9, Tobias Becher4,5,10, Waldemar Bojara11, Christel Weiss12, Theano Papavassiliu4,5, Ibrahim Akin4,5, Martin Borggrefe4,5, Stefan O Schoenberg13, Holger Haubenreisser13, Daniel Overhoff13, Dirk Lossnitzer4,5. 1. First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany. stefan.baumann@umm.de. 2. DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany. stefan.baumann@umm.de. 3. First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. stefan.baumann@umm.de. 4. First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany. 5. DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany. 6. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. 7. Department of Internal Medicine, St. Johannes-Hospital, Dortmund, Germany. 8. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany. 9. The Radiology Center, Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Heidelberg, Germany. 10. Laboratory of Molecular Metabolism, The Rockefeller University, New York, NYC, USA. 11. Community Clinic Mittelrhein, Kemperhof II, The Cardiology Clinic, Koblenz, Germany. 12. Medical Faculty Mannheim, Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany. 13. University Medical Center Mannheim, Faculty of Medicine Mannheim, Institute of Clinical Radiology and Nuclear Medicine, Heidelberg University, Mannheim, Germany.
Abstract
BACKGROUND: Fractional flow reserve based on coronary CT angiography (CT-FFR) is gaining importance for non-invasive hemodynamic assessment of coronary artery disease (CAD). We evaluated the on-site CT-FFR with a machine learning algorithm (CT-FFRML) for the detection of hemodynamically significant coronary artery stenosis in comparison to the invasive reference standard of instantaneous wave free ratio (iFR®). METHODS: This study evaluated patients with CAD who had a clinically indicated coronary computed tomography angiography (cCTA) and underwent invasive coronary angiography (ICA) with iFR®-measurements. Standard cCTA studies were acquired with third-generation dual-source computed tomography and analyzed with on-site prototype CT-FFRML software. RESULTS: We enrolled 40 patients (73% males, mean age 67 ± 12 years) who had iFR®-measurement and CT-FFRML calculation. The mean calculation time of CT-FFRML values was 11 ± 2 min. The CT-FFRML algorithm showed, on per-patient and per-lesion level, respectively, a sensitivity of 92% (95% CI 64-99%) and 87% (95% CI 59-98%), a specificity of 96% (95% CI 81-99%) and 95% (95% CI 84-99%), a positive predictive value of 92% (95% CI 64-99%), and 87% (95% CI 59-98%), and a negative predictive value of 96% (95% CI 81-99%) and 95% (95% CI 84-99%). The area under the receiver operating characteristic curve for CT-FFRML on per-lesion level was 0.97 (95% CI 0.91-1.00). Per lesion, the Pearson's correlation between the CT-FFRML and iFR® showed a strong correlation of r = 0.82 (p < 0.0001; 95% CI 0.715-0.920). CONCLUSION: On-site CT-FFRML correlated well with the invasive reference standard of iFR® and allowed for the non-invasive detection of hemodynamically significant coronary stenosis.
BACKGROUND: Fractional flow reserve based on coronary CT angiography (CT-FFR) is gaining importance for non-invasive hemodynamic assessment of coronary artery disease (CAD). We evaluated the on-site CT-FFR with a machine learning algorithm (CT-FFRML) for the detection of hemodynamically significant coronary artery stenosis in comparison to the invasive reference standard of instantaneous wave free ratio (iFR®). METHODS: This study evaluated patients with CAD who had a clinically indicated coronary computed tomography angiography (cCTA) and underwent invasive coronary angiography (ICA) with iFR®-measurements. Standard cCTA studies were acquired with third-generation dual-source computed tomography and analyzed with on-site prototype CT-FFRML software. RESULTS: We enrolled 40 patients (73% males, mean age 67 ± 12 years) who had iFR®-measurement and CT-FFRML calculation. The mean calculation time of CT-FFRML values was 11 ± 2 min. The CT-FFRML algorithm showed, on per-patient and per-lesion level, respectively, a sensitivity of 92% (95% CI 64-99%) and 87% (95% CI 59-98%), a specificity of 96% (95% CI 81-99%) and 95% (95% CI 84-99%), a positive predictive value of 92% (95% CI 64-99%), and 87% (95% CI 59-98%), and a negative predictive value of 96% (95% CI 81-99%) and 95% (95% CI 84-99%). The area under the receiver operating characteristic curve for CT-FFRML on per-lesion level was 0.97 (95% CI 0.91-1.00). Per lesion, the Pearson's correlation between the CT-FFRML and iFR® showed a strong correlation of r = 0.82 (p < 0.0001; 95% CI 0.715-0.920). CONCLUSION: On-site CT-FFRML correlated well with the invasive reference standard of iFR® and allowed for the non-invasive detection of hemodynamically significant coronary stenosis.
Authors: S Baumann; D Overhoff; C Tesche; G Korosoglou; S Kelle; M Nassar; S J Buss; F Andre; M Renker; U J Schoepf; I Akin; S Waldeck; S O Schoenberg; D Lossnitzer Journal: Herz Date: 2022-03-04 Impact factor: 1.443
Authors: Jonathan James Hyett Bray; Moghees Ahmad Hanif; Mohammad Alradhawi; Jacob Ibbetson; Surinder Singh Dosanjh; Sabrina Lucy Smith; Mahmood Ahmad; Dominic Pimenta Journal: Eur Heart J Open Date: 2022-03-17
Authors: Fay M A Nous; Ricardo P J Budde; Marisa M Lubbers; Yuzo Yamasaki; Isabella Kardys; Tobias A Bruning; Jurgen M Akkerhuis; Marcel J M Kofflard; Bas Kietselaer; Tjebbe W Galema; Koen Nieman Journal: Eur Radiol Date: 2020-03-12 Impact factor: 5.315
Authors: Hendrik Wienemann; Marcel C Langenbach; Victor Mauri; Maryam Banazadeh; Konstantin Klein; Christopher Hohmann; Samuel Lee; Isabel Breidert; Alexander Hof; Kaveh Eghbalzadeh; Elmar Kuhn; Marcel Halbach; David Maintz; Stephan Baldus; Alexander Bunck; Matti Adam Journal: J Cardiovasc Dev Dis Date: 2022-04-14
Authors: Dirk Lossnitzer; Selina Klenantz; Florian Andre; Johannes Goerich; U Joseph Schoepf; Kyle L Pazzo; Andre Sommer; Matthias Brado; Friedemann Gückel; Roman Sokiranski; Tobias Becher; Ibrahim Akin; Sebastian J Buss; Stefan Baumann Journal: BMC Cardiovasc Disord Date: 2022-02-05 Impact factor: 2.298
Authors: Stefan Baumann; Markus Hirt; Christina Rott; Gökce H Özdemir; Christian Tesche; Tobias Becher; Christel Weiss; Svetlana Hetjens; Ibrahim Akin; Stefan O Schoenberg; Martin Borggrefe; Sonja Janssen; Daniel Overhoff; Dirk Lossnitzer Journal: J Clin Med Date: 2020-03-06 Impact factor: 4.241