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Anonymous Comparison of Various Angiography-Derived Fractional Flow Reserve Software With Pressure-Derived
Kai Ninomiya1, Patrick W Serruys2, Nozomi Kotoku1
1Department of Cardiology, National University of Ireland, Galway, Galway, Ireland.
JACC. Cardiovascular Interventions
|May 16, 2023
Summary
Angiography-derived fractional flow reserve (angio-FFR) software shows useful diagnostic accuracy for predicting pressure wire-FFR, outperforming 2D-QCA. However, its accuracy did not match prior validation studies, necessitating further clinical trials.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Medical Device Technology
Background:
- Angiography-derived fractional flow reserve (angio-FFR) software has shown promise, with prior validation studies reporting high area under the receiver-operating characteristic curve (AUC) values (0.93-0.97) against pressure wire-derived fractional flow reserve (PW-FFR).
- Quantitative coronary angiography (QCA) measures percent diameter stenosis (%DS) but has limitations in assessing hemodynamic significance.
Purpose of the Study:
- To independently evaluate the diagnostic accuracy of five different angio-FFR software solutions in a prospective cohort.
- To compare the performance of angio-FFR software against 2D-QCA %DS for predicting significant coronary artery stenosis (FFR ≤0.80).
Main Methods:
- An independent core lab prospectively analyzed 390 vessels, correlating angio-FFR measurements with invasively derived PW-FFR and instantaneous wave-free ratio.
- A "matcher investigator" standardized angio-FFR measurements by co-localizing pressure wire sites and providing consistent angiographic views and frame selection to blinded analysts.
- The diagnostic performance of each angio-FFR software was compared to 2D-QCA %DS using AUC analysis.
Main Results:
- All five angio-FFR software options demonstrated high vessel analyzability rates (92.1%-100%).
- The AUCs for predicting FFR ≤0.80 ranged from 0.73 to 0.75 for the angio-FFR software, significantly outperforming 2D-QCA %DS (AUC 0.65).
- Despite superior performance over 2D-QCA, the AUCs for angio-FFR did not reach the levels reported in previous vendor-specific validation studies.
Conclusions:
- Independent core lab evaluation confirms that angio-FFR software offers useful diagnostic accuracy for predicting PW-FFR, outperforming traditional 2D-QCA %DS.
- The observed diagnostic accuracy is lower than previously reported in vendor validation studies.
- Further large-scale clinical trials are essential to confirm the intrinsic clinical value of angio-FFR technology.
