CT-derived fractional flow reserve for anatomically long-segment coronary disease: a multicentre diagnostic accuracy study
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Published on: April 13, 2015
Ziyu An1, Zhao Ma1, Min Zhang1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China.
Objectives:
To evaluate the diagnostic performance of CT-derived fractional flow reserve (CT-FFR) for detecting haemodynamically significant coronary disease in patients with anatomically long-segment lesions.
Materials And Methods:
This retrospective multicentre study included patients who underwent coronary CT angiography and invasive pressure-wire FFR within 30 days. Anatomically long-segment disease was defined as lesion length ≥ 20 mm. Invasive FFR ≤ 0.80 was the reference standard. CT-FFR was assessed at vessel and patient levels, with patient-level CT-FFR defined as the minimum value per patient and patient-level disease as any invasive FFR ≤ 0.80. Diagnostic discrimination, threshold-based classification, and Bland-Altman agreement were evaluated.
Results:
The diagnostic cohort included 329 patients and 377 vessels; 137 patients and 144 vessels had anatomically long-segment disease. At the vessel level, CT-FFR achieved an AUC of 0.941 (95% CI: 0.917-0.966), sensitivity of 94.3%, specificity of 83.7%, and accuracy of 88.6%. In anatomically long-segment vessels, the AUC was 0.961 (95% CI: 0.922-1.000), with sensitivity of 95.7%, specificity of 92.2%, and accuracy of 94.4%. At the patient level, the overall AUC was 0.941 (95% CI: 0.915-0.967) and 0.971 (95% CI: 0.934-1.000) in anatomically long-segment disease. Mean bias was small, although limits of agreement were clinically relevant.
Conclusion:
CT-FFR showed high diagnostic discrimination for invasive FFR-defined ischaemia, including in anatomically long-segment disease. However, agreement limits and threshold-zone uncertainty support its use as a non-invasive physiological adjunct rather than a direct substitute for invasive pressure-wire assessment.
Key Points:
Question Does machine learning-based CT-FFR maintain diagnostic performance for invasive FFR-defined ischaemia in anatomically long-segment coronary lesions? Findings CT-derived FFR showed high diagnostic discrimination overall and maintained performance in anatomically long-segment disease, although subgroup comparisons remained exploratory. Clinical relevance CT-derived FFR may provide non-invasive physiological information in anatomically long-segment coronary disease before invasive angiography, while values near the 0.80 threshold require cautious interpretation.
