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Enhanced diagnosis of ischemic coronary artery stenosis using CT-derived fractional flow reserve based on
Gang Yang1, Qiucang Xue2, Jiani Yin2
1Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, China.
Insights
A new CT-FFR algorithm using CFD accurately assesses coronary artery stenosis, outperforming standard CCTA for diagnosing ischemia. This non-invasive method is reliable even in calcified vessels, advancing precision cardiovascular care.
Area of Science:
- Cardiovascular Imaging
- Computational Fluid Dynamics
- Medical Diagnostics
Background:
- Coronary artery disease (CAD) is a major global health concern.
- Conventional CT angiography (CCTA) has limitations in assessing the functional significance of coronary stenosis.
- Non-invasive physiological assessment methods are needed for improved CAD evaluation.
Purpose of the Study:
- To evaluate the diagnostic performance of a CT-FFR algorithm derived from computational fluid dynamics (CFD).
- To determine the algorithm's ability to identify functionally significant (ischemic) coronary artery stenosis.
- To compare CT-FFR diagnostic accuracy against anatomical assessment by CCTA.
Main Methods:
- Retrospective analysis of 184 coronary vessels from 171 patients who underwent both CCTA and invasive coronary angiography (ICA).
- Computation of CT-FFR and quantitative flow ratio (QFR), with QFR ≤0.8 defining ischemia.
- Comparative analysis of CT-FFR diagnostic capabilities versus CCTA's anatomical assessment.
Main Results:
- CT-FFR showed superior diagnostic performance compared to CCTA (AUC 0.839 vs. 0.637, P<0.001).
- Per-vessel sensitivity, specificity, and accuracy for CT-FFR were 95.5%, 74.2%, and 91.8%, respectively.
- CT-FFR maintained high accuracy in intermediate lesions and was unaffected by vessel calcification (Agatston scores).
Conclusions:
- CT-FFR based on CFD provides a reliable, non-invasive method for functional assessment of coronary stenosis.
- The algorithm demonstrates diagnostic superiority over CCTA.
- CT-FFR's consistent performance, particularly in calcified vessels, underscores its clinical value in personalized cardiovascular medicine.
Background:
Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Conventional CCTA has limited ability to evaluate functional significance of stenosis, highlighting the need for non-invasive physiological assessment methods.
Objective:
This study aimed to assess the diagnostic performance of a CT-FFR algorithm based on CFD in identifying ischemic coronary artery stenosis.
Methods:
A total of 184 vessels from 171 patients undergoing both CCTA and ICA were retrospectively analyzed. CT-FFR and QFR were computed, with QFR ≤0.8 serving as the reference standard for ischemia. The diagnostic capabilities of CT-FFR were compared with anatomical evaluation via CCTA.
Results:
CT-FFR demonstrated superior diagnostic performance over CCTA, with per-vessel sensitivity of 95.5%, specificity of 74.2%, and accuracy of 91.8% (AUC: 0.839 vs. 0.637, P<0.001). In lesions with intermediate QFR values (0.75-0.85), CT-FFR maintained high diagnostic accuracy (79.4%) and AUC (0.785), outperforming CCTA. Furthermore, CT-FFR remained reliable across various calcification levels, with diagnostic efficacy unaffected by Agatston scores.
Conclusion:
CT-FFR based on CFD offers a robust, non-invasive solution for the functional assessment of coronary stenosis. Its diagnostic superiority over CCTA and consistent performance in calcified vessels highlight its clinical utility in precision cardiovascular care.
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