Accuracy and Reproducibility of Coronary Angiography-Derived Fractional Flow Reserve in the Assessment of Coronary Lesion Severity

Overview

Journal Int J Gen Med

Publisher Dove Medical Press

Specialty General Medicine

Date 2023 Sep 4

PMID 37662502

Authors

Guojian Yang

Le Li

Xi Peng

Guodong Tang

Naixin Zheng

Ying Zhao

Hui Li

Huiping Zhang

Fucheng Sun

Hu Ai

Affiliations

Soon will be listed here.

Abstract

Purpose: Coronary angiography-derived fractional flow reserve (caFFR) is a novel computational flow dynamics (CFD)-derived assessment of coronary vessel flow with good diagnostic performance. Herein, we performed a retrospective study to evaluate the reproducibility of caFFR findings between observers and investigate the diagnostic performance of caFFR for coronary stenosis defined as FFR ≤0.80, especially in the grey zone (0.75≤caFFR ≤0.80).

Patients And Methods: A total of 150 patients (167 coronary vessels) underwent caFFR (with FlashAngio used for calculation of flow variables) and subsequent invasive fractional flow reserve (FFR) measurements. Outcomes, including reproducibility, were compared for vessels in and outside the grey zone.

Results: The correlation of caFFR findings was good between the two laboratories (r = 0.723, <0.001). The AUC of ROC were both high for caFFR-CoreLab1 and caFFR-CoreLab2 (0.975 and 0.883). The diagnostic accuracy, sensitivity, specificity, and negative and positive predictive values were not significantly different between the two laboratories (>0.05). caFFR had a strong correlation with measures to FFR (=0.911, 0.001). There was no systematic difference between caFFR and FFR on Bland-Altman analysis in and outside the grey zone. There was no difference in diagnostic accuracy between the grey and non-grey zones in the prediction of FFR ≤0.80 (=0.09).

Conclusion: The inter-observer reproducibility for caFFR was high, and the diagnostic accuracy of caFFR was good compared to that of FFR.

References

Choi K, Dai N, Li Y, Kim J, Shin D, Lee S . Functional Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv. 2021; 14(15):1670-1684. DOI: 10.1016/j.jcin.2021.05.027. View

Norgaard B, Leipsic J, Gaur S, Seneviratne S, Ko B, Ito H . Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol. 2014; 63(12):1145-1155. DOI: 10.1016/j.jacc.2013.11.043. View

Xu B, Tu S, Song L, Jin Z, Yu B, Fu G . Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial. Lancet. 2021; 398(10317):2149-2159. DOI: 10.1016/S0140-6736(21)02248-0. View

Hennigan B, Berry C, Collison D, Corcoran D, Eteiba H, Good R . Percutaneous coronary intervention versus medical therapy in patients with angina and grey-zone fractional flow reserve values: a randomised clinical trial. Heart. 2020; 106(10):758-764. PMC: 7229900. DOI: 10.1136/heartjnl-2019-316075. View

Chang Y, Chen L, Westra J, Sun Z, Guan C, Zhang Y . Reproducibility of quantitative flow ratio: An inter-core laboratory variability study. Cardiol J. 2018; 27(3):230-237. PMC: 8015972. DOI: 10.5603/CJ.a2018.0105. View

Masdjedi K, van Zandvoort L, Balbi M, Gijsen F, M R Ligthart J, Rutten M . Validation of a three-dimensional quantitative coronary angiography-based software to calculate fractional flow reserve: the FAST study. EuroIntervention. 2019; 16(7):591-599. DOI: 10.4244/EIJ-D-19-00466. View

Tonino P, De Bruyne B, Pijls N, Siebert U, Ikeno F, van t Veer M . Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009; 360(3):213-24. DOI: 10.1056/NEJMoa0807611. View

Xu B, Tu S, Qiao S, Qu X, Chen Y, Yang J . Diagnostic Accuracy of Angiography-Based Quantitative Flow Ratio Measurements for Online Assessment of Coronary Stenosis. J Am Coll Cardiol. 2017; 70(25):3077-3087. DOI: 10.1016/j.jacc.2017.10.035. View

Koo B, Erglis A, Doh J, Daniels D, Jegere S, Kim H . Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained.... J Am Coll Cardiol. 2011; 58(19):1989-97. DOI: 10.1016/j.jacc.2011.06.066. View

10.

De Bruyne B, Pijls N, Kalesan B, Barbato E, Tonino P, Piroth Z . Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012; 367(11):991-1001. DOI: 10.1056/NEJMoa1205361. View

11.

Patel M, Calhoon J, Dehmer G, Grantham J, Maddox T, Maron D . ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association.... J Am Coll Cardiol. 2017; 69(17):2212-2241. DOI: 10.1016/j.jacc.2017.02.001. View

12.

de Bruyne B, Pijls N, Bartunek J, Kulecki K, Bech J, De Winter H . Fractional flow reserve in patients with prior myocardial infarction. Circulation. 2001; 104(2):157-62. DOI: 10.1161/01.cir.104.2.157. View

13.

Pijls N, de Bruyne B, Peels K, van der Voort P, Bonnier H, Bartunek J Koolen J . Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996; 334(26):1703-8. DOI: 10.1056/NEJM199606273342604. View

14.

Pijls N, van Gelder B, van der Voort P, Peels K, Bracke F, Bonnier H . Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation. 1995; 92(11):3183-93. DOI: 10.1161/01.cir.92.11.3183. View

15.

Shin D, Lee J, Lee S, Hwang D, Choi K, Kim H . Non-randomized comparison between revascularization and deferral for intermediate coronary stenosis with abnormal fractional flow reserve and preserved coronary flow reserve. Sci Rep. 2021; 11(1):9126. PMC: 8080642. DOI: 10.1038/s41598-021-88732-4. View

16.

Kang D, Ahn J, Lee C, Lee P, Park D, Kang S . Deferred vs. performed revascularization for coronary stenosis with grey-zone fractional flow reserve values: data from the IRIS-FFR registry. Eur Heart J. 2018; 39(18):1610-1619. DOI: 10.1093/eurheartj/ehy079. View

17.

Cook C, Petraco R, Shun-Shin M, Ahmad Y, Nijjer S, Al-Lamee R . Diagnostic Accuracy of Computed Tomography-Derived Fractional Flow Reserve : A Systematic Review. JAMA Cardiol. 2017; 2(7):803-810. DOI: 10.1001/jamacardio.2017.1314. View

18.

Xue J, Li J, Sun D, Sheng L, Gong Y, Wang D . Functional Evaluation of Intermediate Coronary Lesions with Integrated Computed Tomography Angiography and Invasive Angiography in Patients with Stable Coronary Artery Disease. J Transl Int Med. 2023; 10(3):255-263. PMC: 9901557. DOI: 10.2478/jtim-2022-0018. View

19.

Davies J, Sen S, Dehbi H, Al-Lamee R, Petraco R, Nijjer S . Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI. N Engl J Med. 2017; 376(19):1824-1834. DOI: 10.1056/NEJMoa1700445. View

20.

Ai H, Zheng N, Li L, Yang G, Li H, Tang G . Agreement of Angiography-Derived and Wire-Based Fractional Flow Reserves in Percutaneous Coronary Intervention. Front Cardiovasc Med. 2021; 8:654392. PMC: 8102686. DOI: 10.3389/fcvm.2021.654392. View