Evaluation of fractional flow reserve in patients with stable angina: can CT compete with angiography?

BackgroundWe aimed to compare the performance of FFRCT and FFRQCA in assessing the functional significance of coronary artery stenosis in patients suffering from coronary artery disease with stable angina.MethodA total of 101 stable coronary heart disease (CAD) patients with 181 lesions were recruited. FFRCT and FFRQCA were compared using invasive fractional flow reserve (FFR) as a reference standard. Comparisons between FFRCT and FFRQCA were conducted based on strategies of the geometric reconstruction, boundary conditions, and geometric characteristics. The performance of FFRCT and FFRQCA in detecting hemodynamic significance was also investigated.ResultsThe performance of FFRCT and FFRQCA in discriminating hemodynamically significant lesions was compared. Good correlation and agreement with invasive FFR was found using FFRCT and FFRQCA (r=0.809, p<0.001 and r=0.755, p<0.001). A significant difference was observed in the complex coronary artery tree, in which relatively better prediction was observed using FFRCT than FFRQCA when analyzing the stenosis distributed in the middle segment of a stenotic branch (p=0.036). Moreover, FFRCT was found to be better at predicting hemodynamically insignificant stenosis than FFRQCA (p=0.007), while the performance of the two parameters was similar in discriminating functional significant lesions using an FFR threshold of 0.8 as a reference standard.ConclusionFFR(CT) and FFRQCA could both accurately rule out functional insignificant lesions in stable CAD patients. FFRCT was found to be better for the noninvasive screening of CAD patients with stable angina than FFRQCA.Key Points center dot FFR(CT)and FFR(QCA)were both in good correlation and agreement with invasive FFR measurements.center dot FFR(CT)is superior in accuracy and consistency compared to FFR(QCA)in patients with stenoses distributed in left coronary artery.center dot The noninvasive nature of FFR(CT)could provide potential benefit for stable CAD patients on disease management.