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 Via Noninvasive Fractional Flow Reserve) study

Bon Kwon Koo, Andrejs Erglis, Joon Hyung Doh, David V. Daniels, Sanda Jegere, Hyo Soo Kim, Allison Dunning, Tony Defrance, Alexandra Lansky, Jonathan Leipsic, James K. Min

Research output: Contribution to journalArticle

650 Citations (Scopus)

Abstract

Objectives: The aim of this study was to determine the diagnostic performance of a new method for quantifying fractional flow reserve (FFR) with computational fluid dynamics (CFD) applied to coronary computed tomography angiography (CCTA) data in patients with suspected or known coronary artery disease (CAD). Background: Measurement of FFR during invasive coronary angiography is the gold standard for identifying coronary artery lesions that cause ischemia and improves clinical decision-making for revascularization. Computation of FFR from CCTA data (FFR CT) provides a noninvasive method for identifying ischemia-causing stenosis; however, the diagnostic performance of this new method is unknown. Methods: Computation of FFR from CCTA data was performed on 159 vessels in 103 patients undergoing CCTA, invasive coronary angiography, and FFR. Independent core laboratories determined FFR CT and CAD stenosis severity by CCTA. Ischemia was defined by an FFR CT and FFR ≤0.80, and anatomically obstructive CAD was defined as a CCTA with stenosis <50%. Diagnostic performance of FFR CT and CCTA stenosis was assessed with invasive FFR as the reference standard. Results: Fifty-six percent of patients had <1 vessel with FFR ≤0.80. On a per-vessel basis, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 84.3%, 87.9%, 82.2%, 73.9%, 92.2%, respectively, for FFR CT and were 58.5%, 91.4%, 39.6%, 46.5%, 88.9%, respectively, for CCTA stenosis. The area under the receiver-operator characteristics curve was 0.90 for FFR CT and 0.75 for CCTA (p = 0.001). The FFR CT and FFR were well correlated (r = 0.717, p < 0.001) with a slight underestimation by FFR CT (0.022 ± 0.116, p = 0.016). Conclusions: Noninvasive FFR derived from CCTA is a novel method with high diagnostic performance for the detection and exclusion of coronary lesions that cause ischemia. (The Diagnosis of ISChemia-Causing Stenoses Obtained Via NoninvasivE FRactional FLOW Reserve; NCT01189331)

Original languageEnglish
Pages (from-to)1989-1997
Number of pages9
JournalJournal of the American College of Cardiology
Volume58
Issue number19
DOIs
StatePublished - 1 Nov 2011

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Coronary Stenosis
Angiography
Pathologic Constriction
Ischemia
Coronary Artery Disease
Coronary Angiography
Computed Tomography Angiography
Hydrodynamics
Coronary Vessels
Sensitivity and Specificity

Keywords

  • computational fluid dynamics
  • coronary CT angiography
  • fractional flow reserve

Cite this

@article{33ae3380e2bb42caac09893f5ef4d830,
title = "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 Via Noninvasive Fractional Flow Reserve) study",
abstract = "Objectives: The aim of this study was to determine the diagnostic performance of a new method for quantifying fractional flow reserve (FFR) with computational fluid dynamics (CFD) applied to coronary computed tomography angiography (CCTA) data in patients with suspected or known coronary artery disease (CAD). Background: Measurement of FFR during invasive coronary angiography is the gold standard for identifying coronary artery lesions that cause ischemia and improves clinical decision-making for revascularization. Computation of FFR from CCTA data (FFR CT) provides a noninvasive method for identifying ischemia-causing stenosis; however, the diagnostic performance of this new method is unknown. Methods: Computation of FFR from CCTA data was performed on 159 vessels in 103 patients undergoing CCTA, invasive coronary angiography, and FFR. Independent core laboratories determined FFR CT and CAD stenosis severity by CCTA. Ischemia was defined by an FFR CT and FFR ≤0.80, and anatomically obstructive CAD was defined as a CCTA with stenosis <50{\%}. Diagnostic performance of FFR CT and CCTA stenosis was assessed with invasive FFR as the reference standard. Results: Fifty-six percent of patients had <1 vessel with FFR ≤0.80. On a per-vessel basis, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 84.3{\%}, 87.9{\%}, 82.2{\%}, 73.9{\%}, 92.2{\%}, respectively, for FFR CT and were 58.5{\%}, 91.4{\%}, 39.6{\%}, 46.5{\%}, 88.9{\%}, respectively, for CCTA stenosis. The area under the receiver-operator characteristics curve was 0.90 for FFR CT and 0.75 for CCTA (p = 0.001). The FFR CT and FFR were well correlated (r = 0.717, p < 0.001) with a slight underestimation by FFR CT (0.022 ± 0.116, p = 0.016). Conclusions: Noninvasive FFR derived from CCTA is a novel method with high diagnostic performance for the detection and exclusion of coronary lesions that cause ischemia. (The Diagnosis of ISChemia-Causing Stenoses Obtained Via NoninvasivE FRactional FLOW Reserve; NCT01189331)",
keywords = "computational fluid dynamics, coronary CT angiography, fractional flow reserve",
author = "Koo, {Bon Kwon} and Andrejs Erglis and Doh, {Joon Hyung} and Daniels, {David V.} and Sanda Jegere and Kim, {Hyo Soo} and Allison Dunning and Tony Defrance and Alexandra Lansky and Jonathan Leipsic and Min, {James K.}",
year = "2011",
month = "11",
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doi = "10.1016/j.jacc.2011.06.066",
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journal = "Journal of the American College of Cardiology",
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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 Via Noninvasive Fractional Flow Reserve) study. / Koo, Bon Kwon; Erglis, Andrejs; Doh, Joon Hyung; Daniels, David V.; Jegere, Sanda; Kim, Hyo Soo; Dunning, Allison; Defrance, Tony; Lansky, Alexandra; Leipsic, Jonathan; Min, James K.

In: Journal of the American College of Cardiology, Vol. 58, No. 19, 01.11.2011, p. 1989-1997.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms

T2 - Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study

AU - Koo, Bon Kwon

AU - Erglis, Andrejs

AU - Doh, Joon Hyung

AU - Daniels, David V.

AU - Jegere, Sanda

AU - Kim, Hyo Soo

AU - Dunning, Allison

AU - Defrance, Tony

AU - Lansky, Alexandra

AU - Leipsic, Jonathan

AU - Min, James K.

PY - 2011/11/1

Y1 - 2011/11/1

N2 - Objectives: The aim of this study was to determine the diagnostic performance of a new method for quantifying fractional flow reserve (FFR) with computational fluid dynamics (CFD) applied to coronary computed tomography angiography (CCTA) data in patients with suspected or known coronary artery disease (CAD). Background: Measurement of FFR during invasive coronary angiography is the gold standard for identifying coronary artery lesions that cause ischemia and improves clinical decision-making for revascularization. Computation of FFR from CCTA data (FFR CT) provides a noninvasive method for identifying ischemia-causing stenosis; however, the diagnostic performance of this new method is unknown. Methods: Computation of FFR from CCTA data was performed on 159 vessels in 103 patients undergoing CCTA, invasive coronary angiography, and FFR. Independent core laboratories determined FFR CT and CAD stenosis severity by CCTA. Ischemia was defined by an FFR CT and FFR ≤0.80, and anatomically obstructive CAD was defined as a CCTA with stenosis <50%. Diagnostic performance of FFR CT and CCTA stenosis was assessed with invasive FFR as the reference standard. Results: Fifty-six percent of patients had <1 vessel with FFR ≤0.80. On a per-vessel basis, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 84.3%, 87.9%, 82.2%, 73.9%, 92.2%, respectively, for FFR CT and were 58.5%, 91.4%, 39.6%, 46.5%, 88.9%, respectively, for CCTA stenosis. The area under the receiver-operator characteristics curve was 0.90 for FFR CT and 0.75 for CCTA (p = 0.001). The FFR CT and FFR were well correlated (r = 0.717, p < 0.001) with a slight underestimation by FFR CT (0.022 ± 0.116, p = 0.016). Conclusions: Noninvasive FFR derived from CCTA is a novel method with high diagnostic performance for the detection and exclusion of coronary lesions that cause ischemia. (The Diagnosis of ISChemia-Causing Stenoses Obtained Via NoninvasivE FRactional FLOW Reserve; NCT01189331)

AB - Objectives: The aim of this study was to determine the diagnostic performance of a new method for quantifying fractional flow reserve (FFR) with computational fluid dynamics (CFD) applied to coronary computed tomography angiography (CCTA) data in patients with suspected or known coronary artery disease (CAD). Background: Measurement of FFR during invasive coronary angiography is the gold standard for identifying coronary artery lesions that cause ischemia and improves clinical decision-making for revascularization. Computation of FFR from CCTA data (FFR CT) provides a noninvasive method for identifying ischemia-causing stenosis; however, the diagnostic performance of this new method is unknown. Methods: Computation of FFR from CCTA data was performed on 159 vessels in 103 patients undergoing CCTA, invasive coronary angiography, and FFR. Independent core laboratories determined FFR CT and CAD stenosis severity by CCTA. Ischemia was defined by an FFR CT and FFR ≤0.80, and anatomically obstructive CAD was defined as a CCTA with stenosis <50%. Diagnostic performance of FFR CT and CCTA stenosis was assessed with invasive FFR as the reference standard. Results: Fifty-six percent of patients had <1 vessel with FFR ≤0.80. On a per-vessel basis, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 84.3%, 87.9%, 82.2%, 73.9%, 92.2%, respectively, for FFR CT and were 58.5%, 91.4%, 39.6%, 46.5%, 88.9%, respectively, for CCTA stenosis. The area under the receiver-operator characteristics curve was 0.90 for FFR CT and 0.75 for CCTA (p = 0.001). The FFR CT and FFR were well correlated (r = 0.717, p < 0.001) with a slight underestimation by FFR CT (0.022 ± 0.116, p = 0.016). Conclusions: Noninvasive FFR derived from CCTA is a novel method with high diagnostic performance for the detection and exclusion of coronary lesions that cause ischemia. (The Diagnosis of ISChemia-Causing Stenoses Obtained Via NoninvasivE FRactional FLOW Reserve; NCT01189331)

KW - computational fluid dynamics

KW - coronary CT angiography

KW - fractional flow reserve

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DO - 10.1016/j.jacc.2011.06.066

M3 - Article

C2 - 22032711

AN - SCOPUS:80055019355

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SP - 1989

EP - 1997

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 19

ER -