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Fractional flow reserve using computed tomography for assessing coronary artery disease: a meta-analysis
Hemang B Panchal1, Sreenivas P Veeranki, Samit Bhatheja
1aDivision of Cardiology, Department of Internal Medicine, East Tennessee State University, Johnson City, TennesseebDepartment of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TexascDepartment of Internal Medicine, East Tennessee State University, Johnson City, TennesseedDivision of Cardiovascular Medicine, Department of Internal Medicine, University of California, San DiegoeDivision of Cardiology, Department of Internal Medicine, University of California, Los Angeles, Torrance, CaliforniafDepartment of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.
Aims:
Noninvasive fractional flow reserve (FFR) measurement with computed tomography (FFRCT) is a newly described method for assessing functional significance of coronary disease. The objective of this meta-analysis is to determine the diagnostic performance of FFRCT in the assessment of hemodynamically significant coronary artery stenosis.
Methods:
PubMed and the Cochrane Center Register of Controlled Trials were searched from January 2000 through February 2015. Six original studies were found comparing FFRCT to invasive FFR in evaluating hemodynamic significance of coronary lesions (1354 vessels; 812 patients). Lesions were considered hemodynamically significant if invasive FFR was 0.80 or less. FFRCT used the same cutoff as invasive FFR to be considered as a positive test. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were calculated.
Results:
One-third of the lesions (n = 443) were hemodynamically significant. The pooled per-vessel analysis showed that the sensitivity, specificity, negative and positive likelihood ratios, and diagnostic odds ratio of FFRCT to diagnose hemodynamically significant coronary disease were 0.84 [95% confidence interval (CI): 0.80-0.87], 0.76 (95% CI: 0.73-0.79), 0.22 (95% CI: 0.17-0.29), 3.48 (95% CI: 2.21-5.47), and 16.82 (95% CI: 8.20-34.49), respectively.
Conclusion:
The results of this meta-analysis demonstrate that FFRCT results correlate closely with invasive coronary angiography and FFR measurement. It is a feasible noninvasive method to assess hemodynamic significance of coronary lesions in patients with stable coronary artery disease.
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