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Prognosis of CT-derived Fractional Flow Reserve in the Prediction of Clinical Outcomes
Charis G McNabney1, Stephanie L Sellers1, Ryan J A Wilson1
1Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver, British Columbia, Canada, V6Z 1Y6; Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, Canada (R.J.A.W.); Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark (B.L.N.); School of Medicine, University of Cambridge, Cambridge, England (J.R.W.M.).
Insights
Fractional flow reserve derived from coronary CT (FFRCT) predicts clinical events. A positive FFRCT result without significant stenosis does not increase intermediate-term risk.
Area of Science:
- Cardiovascular imaging and intervention
- Non-invasive cardiology
- Diagnostic accuracy in cardiovascular disease
Background:
- Fractional flow reserve (FFR) is a key metric for assessing the functional significance of coronary artery stenosis.
- Coronary CT angiography (CCTA) is increasingly used for anatomical assessment.
- FFR derived from CCTA (FFRCT) offers a non-invasive method to evaluate the hemodynamic impact of stenosis.
Purpose of the Study:
- To evaluate the prognostic value of FFRCT in routine clinical practice.
- To determine if FFRCT can predict intermediate-term clinical outcomes.
- To assess the independent predictive value of FFRCT and anatomical stenosis for adverse events.
Main Methods:
- Retrospective analysis of 200 patients who underwent FFRCT between October 2015 and June 2017.
- Patients categorized by significant stenosis (SS ≥ 50% diameter stenosis) and FFRCT positivity (FFRCT < 0.80).
- Follow-up for vessel-oriented clinical events (VOCEs), including revascularization, myocardial infarction, and cardiac mortality.
Main Results:
- At median follow-up of 477 days, 26 VOCE endpoints occurred in 22 patients.
- Zero VOCE events in SS-negative and FFRCT-negative patients (n=58).
- Higher VOCE rates in SS-positive/FFRCT-negative (10.1%) and SS-positive/FFRCT-positive (35.3%) groups.
- Both FFRCT and SS were independent predictors of VOCE on multivariable Cox regression.
Conclusions:
- FFRCT and anatomical stenosis are independent predictors of intermediate-term outcomes.
- A positive FFRCT result in the absence of significant stenosis (>50%) is not associated with increased risk.
- FFRCT provides valuable prognostic information in the assessment of coronary artery disease.
Purpose:
To examine the prognostic implication of fractional flow reserve (FFR) derived from coronary CT (FFRCT) in routine clinical practice.
Materials And Methods:
Patients referred for FFRCT analysis at a single center between October 2015 and June 2017 were retrospectively included and followed up for rates of invasive angiography and clinical events. Two hundred seven patients underwent successful FFRCT analysis with seven lost to follow-up, leaving 200 (mean age ± standard deviation, 62.4 years ± 10.0; 49 [24.5%] women) patients for analysis. At coronary CT angiography, patients were categorized as having significant stenosis (SS) in the presence of a diameter stenosis greater than or equal to 50% (hereafter, SS positive) and flow limitation in the presence of a postlesion (that is, FFRCT measured 2 cm to the distal aspect of the lesion) FFRCT less than 0.80 (hereafter, FFRCT positive). Vessel-oriented clinical events (VOCEs) were defined as vessel-related late revascularization (>90 days), myocardial infarction, and cardiac mortality.
Results:
At CT angiography, 130 (65%) studies were SS positive and 63 (31.5%) were FFRCT positive. At median follow-up of 477 days (range, 252-859 days), there were 26 VOCE end points in 22 patients: 22 revascularizations and four nonfatal myocardial infarctions. VOCE end points occurred in zero of 58 (0%) of SS-negative and FFRCT negative patients, in eight of 79 (10.1%) of SS-positive and FFRCT-negative patients, in zero of 12 (0%) of SS-negative and FFRCT-positive patients, and in 18 of 51 (35.3%) of SS-positive and FFRCT-positive patients (log-rank χ2 = 30.1; P < .001). At multivariable Cox regression, both FFRCT (hazard ratio per 0.1 decrease, 1.54 [95% confidence interval: 1.1, 2.2] P = .013) and stenosis (hazard ratio per unit increase, 2.16 [95% confidence interval: 1.25, 3.72] P = .006) were independently associated with VOCE.
Conclusion:
Stenosis and FFRCT are independent predictors of intermediate-term outcomes. In the absence of a stenosis greater than 50%, a positive FFRCT result is not associated with an increased intermediate risk.© RSNA, 2019Supplemental material is available for this article.See also commentary by Fairbairn and Bull in this issue.
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