Diagnostic performance of fractional flow reserve derived from coronary CT angiography for detection of lesion-specific ischemia: A multi-center study and meta-analysis

Purpose: To evaluate the diagnostic performance of coronary computed tomography angiography derived fractional flow reserve (CT-FFR) with invasive fractional flow reserve (FFR) in patients with coronary artery disease" before "with invasive fractional flow reserve serving as the reference standard.

Materials and methods: CT-FFR values based on a machine learning algorithm (cFFR_ML) in 183 vessels of 136 patients from four centers were measured with invasive FFR as reference standard. The diagnostic performance from our multicenter study was combined into a meta-analysis following a literature search in Web of Science, PubMed, Cochrane library to identify studies comparing diagnostic performance of coronary computed tomography angiography (CCTA) and CT-FFR. Sensitivity, specificity, accuracy were analyzed on both per-vessel and per-patient basis for intermediate lesions and by algorithm.

Results: Our multicenter study demonstrated sensitivities, specificities, and accuracies of cFFR_ML and CCTA of 0.85, 0.94, 0.90, and 0.95, 0.28, 0.55 on a per-vessel basis, respectively. For our meta-analysis, pooled sensitivities, specificities, and accuracies of CT-FFR and CCTA were 0.85, 0.82, 0.82, and 0.85, 0.57, 0.65 with AUC of 0.86 (95%CI: 0.83˜0.89) and 0.83 (95%CI: 0.79˜0.86) on a per-vessel basis, respectively. The sensitivity, specificity and accuracy for intermediate lesions using cFFR_ML were 0.84, 0.92, and 0.89. No significant difference was found among different algorithms of CT-FFR (P < 0.001).

Conslusion: This multicenter study with meta-analysis showed that CT-FFR had a high diagnostic accuracy in determining ischemia-specific lesions and intermediate lesions. There was no significant difference when comparing the combined diagnostic performance of different algorithms of CT-FFR with invasive FFR as the reference standard.