Related Experiment Video
Updated: Nov 25, 2025
Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice
Published on: April 13, 2015
Feasibility and Validity of Computed Tomography-Derived Fractional Flow Reserve in Patients With Severe Aortic
Michael Michail1,2, Abdul-Rahman Ihdayhid1, Andrea Comella1
1Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Australia (M.M., A.-R.I., A.C., U.T., J.D.C., L.M.M., R.P.G., S.J.N., B.S.K., A.J.B.).
Insights
Computed tomography-derived fractional flow reserve (CT-FFR) is safe and feasible for assessing coronary artery disease in patients with severe aortic stenosis. This validated CT-FFR approach supports its clinical use and future research for pre-aortic valve replacement evaluations.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) is prevalent in patients with severe aortic stenosis (AS).
- Computed tomography-derived fractional flow reserve (CT-FFR) is a non-invasive tool for CAD assessment.
- CT-FFR validation in severe AS patients is lacking.
Purpose of the Study:
- To assess the safety and feasibility of CT-FFR in patients with severe AS.
- To validate the accuracy of CT-FFR against invasive fractional flow reserve (FFR).
Main Methods:
- Prospective recruitment of patients with severe AS undergoing invasive FFR and coronary CT angiography (CTA).
- Centralized analysis of CTA for CT-FFR computation.
- Comparison of CT-FFR with invasive FFR (≤0.80 indicating ischemia).
Main Results:
- CT-FFR was successfully computed in 92.3% of patients and 88.2% of vessels.
- No complications were reported during CT-FFR or FFR procedures.
- CT-FFR demonstrated good correlation with invasive FFR (R=0.64, P<0.0001), achieving 76.7% diagnostic accuracy on a per-vessel basis and 76.9% on a per-patient basis.
- The area under the ROC curve for CT-FFR (0.83) was significantly higher than for CTA alone (P=0.01) and quantitative coronary angiography (P<0.001).
Conclusions:
- CT-FFR is a safe and feasible method for evaluating coronary artery disease in patients with severe aortic stenosis.
- The diagnostic accuracy of CT-FFR supports its potential clinical application for coronary evaluation prior to aortic valve replacement.
- This study provides a foundation for further research into CT-FFR's role in managing severe AS patients.
Background:
Coronary artery disease is common in patients with severe aortic stenosis. Computed tomography-derived fractional flow reserve (CT-FFR) is a clinically used modality for assessing coronary artery disease, however, its use has not been validated in patients with severe aortic stenosis. This study assesses the safety, feasibility, and validity of CT-FFR in patients with severe aortic stenosis.
Methods:
Prospectively recruited patients underwent standard-protocol invasive FFR and coronary CT angiography (CTA). CTA images were analyzed by central core laboratory (HeartFlow, Inc) for independent evaluation of CT-FFR. CT-FFR data were compared with FFR (ischemia defined as FFR ≤0.80).
Results:
Forty-two patients (68 vessels) underwent FFR and CTA; 39 patients (92.3%) and 60 vessels (88.2%) had interpretable CTA enabling CT-FFR computation. Mean age was 76.2±6.7 years (71.8% male). No patients incurred complications relating to premedication, CTA, or FFR protocol. Mean FFR and CT-FFR were 0.83±0.10 and 0.77±0.14, respectively. CT calcium score was 1373.3±1392.9 Agatston units. On per vessel analysis, there was positive correlation between FFR and CT-FFR (Pearson correlation coefficient, R=0.64, P<0.0001). Sensitivity, specificity, positive predictive value, and negative predictive values were 73.9%, 78.4%, 68.0%, and 82.9%, respectively, with 76.7% diagnostic accuracy. The area under the receiver-operating characteristic curve for CT-FFR was 0.83 (0.72-0.93, P<0.0001), which was higher than that of CTA and quantitative coronary angiography (P=0.01 and P<0.001, respectively). Bland-Altman plot showed mean bias between FFR and CT-FFR as 0.059±0.110. On per patient analysis, the sensitivity, specificity, positive predictive, and negative predictive values were 76.5%, 77.3%, 72.2%, and 81.0% with 76.9% diagnostic accuracy. The per patient area under the receiver-operating characteristic curve analysis was 0.81 (0.67-0.95, P<0.0001).
Conclusions:
CT-FFR is safe and feasible in patients with severe aortic stenosis. Our data suggests that the diagnostic accuracy of CT-FFR in this cohort potentially enables its use in clinical practice and provides the foundation for future research into the use of CT-FFR for coronary evaluation pre-aortic valve replacement.
More Related Videos
09:36A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
Published on: August 12, 2025
11:16In vitro Assessment of Aortic Regurgitation Using Four-Dimensional Flow Magnetic Resonance Imaging
Published on: February 25, 2022