Related Experiment Video
Updated: Jun 9, 2026
Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
Comparison of Diagnostic Accuracy of CT Derived Fractional Flow Reserve for Predicting Revascularization
Toshimitsu Tsugu1, Kaoru Tanaka1, Dries Belsack1
1Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Insights
Trans-lesion fractional flow reserve (ΔFFRCT) accurately predicts revascularization in coronary artery disease, similar to diameter stenosis. Lesion length significantly influences ΔFFRCT measurements.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Computational Fluid Dynamics
Background:
- CT-derived fractional flow reserve (FFRCT) is crucial for guiding revascularization decisions in coronary artery disease.
- Optimal FFRCT measurement techniques and lesion characterization remain subjects of ongoing research and consensus-building.
Purpose of the Study:
- To evaluate the diagnostic accuracy of different FFRCT measurement methods in predicting the need for revascularization.
- To identify factors, particularly lesion characteristics, that influence FFRCT measurements.
Main Methods:
- 340 patients with ≥50% diameter stenosis (DS) on invasive coronary angiography were analyzed.
- FFRCT was measured using three methods: vessel-distal, lesion-specific, and trans-lesion (ΔFFRCT).
- Vessels were categorized by lesion length (focal vs. diffuse) and DS severity (moderate vs. severe).
Main Results:
- In focal lesions, ΔFFRCT showed predictive ability comparable to DS, outperforming other FFRCT methods.
- Lesion length was identified as the strongest predictor of ΔFFRCT in both focal and diffuse lesions.
- In diffuse lesions, ΔFFRCT's predictive performance was similar to DS and other FFRCT measurements.
Conclusions:
- The predictive performance of ΔFFRCT for revascularization is comparable to DS across both focal and diffuse coronary lesions.
- Lesion length is a significant factor affecting the accuracy and interpretation of ΔFFRCT values.
Purpose:
CT-derived fractional-flow-reserve (FFRCT) is recommended for determining the indication of revascularization. Consensus on optimal fractional-flow-reserve (FFR) measurement methods and lesions is lacking. To investigate the diagnostic accuracy of FFRCT measurement methods for predicting revascularization and factors affecting FFRCT measurement methods.
Methods:
A total of 340 patients (382 vessels) who underwent CT angiography and showed ≥50% diameter stenosis (DS) on invasive coronary angiography were evaluated. Enrolled vessels were classified into four groups according to lesion length (focal, <40 mm; diffuse, ≥40 mm) and DS (moderate, 50%-69%; severe, 70%-99%). FFRCT was measured at the distal end of the vessel (vessel-distal FFRCT), distal to the stenotic lesion (lesion-specific FFRCT), and trans-lesion FFRCT (ΔFFRCT) and compared with DS. Vessel morphology and left ventricular mass were assessed.
Results:
In focal lesions, the predictive ability for revascularization of ΔFFRCT (AUC = 0.71) was comparable to that of DS (AUC = 0.76, p = 0.166) and higher than that of lesion-specific FFRCT (AUC = 0.67, p < 0.001) and vessel-distal FFRCT (AUC = 0.63, p < 0.001). Multivariable analysis showed that lesion length was the strongest predictor of ΔFFRCT (β-coefficient = 0.42, p = 0.006). In diffuse lesions, the predictive ability for revascularization of ΔFFRCT (AUC = 0.73) was comparable to that of DS (AUC = 0.77, p = 0.667), lesion-specific FFRCT (AUC = 0.72, p = 0.653), and vessel-distal FFRCT (AUC = 0.69, p = 0.242). Multivariable analysis showed that lesion length was the strongest predictor of ΔFFRCT (β-coefficient = 0.99, p < 0.001).
Conclusion:
The predictive performance of ΔFFRCT for revascularization was similar to DS in focal and diffuse lesions. ΔFFRCT was influenced by lesion length.
