Coronary Computed Tomographic Angiography-Derived Fractional Flow Reserve for Therapeutic Decision Making - 01/11/17

Doi : 10.1016/j.amjcard.2017.08.034

Christian Tesche, MD ^a,^b, Rozemarijn Vliegenthart, MD, PhD ^a,^c, Taylor M. Duguay, BS ^a, Carlo N. De Cecco, MD, PhD ^a, Moritz H. Albrecht, MD ^a,^d, Domenico De Santis, MD ^a,^e, Marcel C. Langenbach, MD ^a,^d, Akos Varga-Szemes, MD, PhD ^a, Brian E. Jacobs, BS ^a, David Jochheim, MD ^f, Moritz Baquet, MD ^f, Richard R. Bayer, MD ^a,^g, Sheldon E. Litwin, MD ^a,^g, Ellen Hoffmann, MD ^b, Daniel H. Steinberg, MD ^g, U. Joseph Schoepf, MD ^a,^g,^*
^a Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
^b Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
^c University Medical Center Groningen, Center for Medical Imaging, Department of Radiology, University of Groningen, Groningen, The Netherlands
^d Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
^e Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza,” Rome, Italy
^f Department of Cardiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
^g Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina

^*Corresponding author: Tel: +1 843 876 7146; fax: +1 843 876 3157.

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Abstract

This study investigated the performance of coronary computed tomography angiography (cCTA) with cCTA-derived fractional flow reserve (CT-FFR) compared with invasive coronary angiography (ICA) with fractional flow reserve (FFR) for therapeutic decision making in patients with suspected coronary artery disease (CAD). Seventy-four patients (62 ± 11 years, 62% men) with at least 1 coronary stenosis of ≥50% on clinically indicated dual-source cCTA, who had subsequently undergone ICA with FFR measurement, were retrospectively evaluated. CT-FFR values were computed using an on-site machine-learning algorithm to assess the functional significance of CAD. The therapeutic strategy (optimal medical therapy alone vs revascularization) and the appropriate revascularization procedure (percutaneous coronary intervention vs coronary artery bypass grafting) were selected using cCTA-CT-FFR. Thirty-six patients (49%) had a functionally significant CAD based on ICA-FFR. cCTA-CT-FFR correctly identified a functionally significant CAD and the need of revascularization in 35 of 36 patients (97%). When revascularization was deemed indicated, the same revascularization procedure (32 percutaneous coronary interventions and 3 coronary artery bypass grafting) was chosen in 35 of 35 patients (100%). Overall, identical management strategies were selected in 73 of the 74 patients (99%). cCTA-CT-FFR shows excellent performance to identify patients with and without the need for revascularization and to select the appropriate revascularization strategy. cCTA-CT-FFR as a noninvasive “one-stop shop” has the potential to change diagnostic workflows and to directly inform therapeutic decision making in patients with suspected CAD.

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