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Validity and Diagnostic Performance of Computing Fractional Flow Reserve From 2-Dimensional Coronary Angiography
Vahid Mohammadi1,2, Massoud Ghasemi1, Reza Rahmani1
1Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Background:
Measurement of fractional flow reserve (FFR) is the gold standard for determining the physiologic significance of coronary artery stenosis, but newer software programs can calculate the FFR from 2-dimensional angiography images.
Methods:
A retrospective analysis was conducted using the records of patients with intermediate coronary stenoses who had undergone adenosine FFR (aFFR). To calculate the computed FFR, a software program used simulated coronary blood flow using computational geometry constructed using at least 2 patient-specific angiographic images. Two cardiologists reviewed the angiograms and determined the computational FFR independently. Intraobserver variability was measured using κ analysis and the intraclass correlation coefficient. The correlation coefficient and Bland-Altman plots were used to assess the agreement between the calculated FFR and the aFFR.
Results:
A total of 146 patients were included, with 95 men and 51 women, with a mean (SD) age of 61.1 (9.5) y. The mean (SD) aFFR was 0.847 (0.072), and 41 patients (27.0%) had an aFFR of 0.80 or less. There was a strong intraobserver correlation between the computational FFRs (r = 0.808; P < .001; κ = 0.806; P < .001). There was also a strong correlation between aFFR and computational FFR (r = 0.820; P < .001) and good agreement on the Bland-Altman plot. The computational FFR had a high sensitivity (95.1%) and specificity (90.1%) for detecting an aFFR of 0.80 or less.
Conclusion:
A novel software program provides a feasible method of calculating FFR from coronary angiography images without resorting to pharmacologically induced hyperemia.
