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Published on: April 13, 2015
Optimal Cutoff Value of Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography for Predicting
Yukiko Matsumura-Nakano1, Tetsuma Kawaji2, Hiroki Shiomi1
1Department of Cardiovascular Medicine (Y.M.-N., H.S., K. Kitano, M.Y., H.W., J.T., T. Kato, N.S., S.S., K.O., T. Kimura), Kyoto University Graduate School of Medicine, Japan.
Insights
The optimal cutoff for fractional flow reserve computed tomography angiography (FFRCT) is debated. An FFRCT range of 0.71-0.80 suggests individualized invasive angiography decisions for coronary artery disease.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Diagnostic Accuracy
Background:
- The optimal cutoff value for fractional flow reserve derived from coronary computed tomography angiography (FFRCT) is not definitively established.
- Accurate non-invasive assessment of coronary artery disease (CAD) is crucial for guiding treatment decisions.
Purpose of the Study:
- To evaluate the diagnostic performance of FFRCT using various cutoff values and ranges.
- To determine the optimal FFRCT threshold for identifying hemodynamically significant coronary stenosis.
Main Methods:
- A study involving 93 patients with suspected CAD underwent FFRCT analysis and invasive FFR measurements.
- Diagnostic performance metrics (accuracy, sensitivity, specificity, PPV, NPV) were assessed for different FFRCT cutoff values (≤0.80, ≤0.75, ≤0.70).
- The diagnostic utility of FFRCT ranges was analyzed with invasive FFR ≤0.80 as the gold standard.
Main Results:
- Per-vessel analysis showed varying accuracy, sensitivity, and specificity for different FFRCT cutoffs.
- An FFRCT cutoff of ≤0.70 yielded 83% accuracy, 74% sensitivity, and 89% specificity.
- A 'gray zone' of FFRCT 0.71-0.80 demonstrated high positive predictive value (82%) for FFRCT ≤0.70 and high negative predictive value (94%) for FFRCT >0.80.
Conclusions:
- Individualized decisions for invasive coronary angiography are recommended for FFRCT values between 0.71 and 0.80.
- Clear dichotomous decisions can be made for FFRCT values ≤0.70 and >0.80.
- Further prospective studies are needed to establish an optimal FFRCT-based diagnostic algorithm and evaluate clinical outcomes.
Background:
The optimal cutoff value of fractional flow reserve (FFR) derived from coronary computed tomography angiography (FFRCT) remains unclear.
Methods:
The current study population consisted of 93 patients with 139 vessels, who had suspected coronary artery disease by computed tomography angiography and underwent invasive FFR. We evaluated diagnostic performance of FFRCT according to different FFRCT cutoff values and FFRCT ranges with invasive FFR ≤0.80 as the reference standard.
Results:
In per-vessel analysis, median invasive FFR was 0.85 (interquartile range, 0.75-0.90), and 57 out of 139 vessels (41%) showed hemodynamically significant stenosis (≤0.80). Median FFRCT was 0.77 (interquartile range, 0.66-0.84; mean difference [invasive FFR-FFRCT], 0.06±0.11). Per-vessel accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 73%, 95%, 59%, 61%, and 94% for the cutoff value of FFRCT ≤0.80, 81%, 86%, 78%, 73%, and 89% for FFRCT ≤0.75, and 83%, 74%, 89%, 82%, and 83% for FFRCT ≤0.70, respectively. Per-vessel accuracy across the different ranges of FFRCT ≤0.60, 0.61 to 0.70, 0.71 to 0.80, 0.81 to 0.90, and >0.90 with the cutoff value of FFRCT ≤0.80 were 95%, 74%, 32%, 93%, and 100%, respectively. Setting a gray zone of FFRCT 0.71 to 0.80 provided high positive predictive value (82%; n=42/51) in the range of FFRCT ≤0.70 and high negative predictive value (94%; n=48/51) in FFRCT >0.80.
Conclusions:
This study suggested that referral to invasive coronary angiography should be considered individually in the range of FFRCT 0.71 to 0.80, whereas dichotomous decision could be made in FFRCT ≤0.70 and >0.80. Future prospective studies evaluating clinical outcomes are needed to establish optimal FFRCT-based diagnostic algorithm.
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