The value of fractional flow reserve based on coronary computed tomography angiography with low-dose contrast agent in noninvasive diagnosis of coronary artery disease

Zengkun Wang; Xiaomei Luan; Qian Zhang; Chu Chu; Xiaodie Xu; Huijing Chai; Peiji Song

doi:10.1097/MCA.0000000000001448

The value of fractional flow reserve based on coronary computed tomography angiography with low-dose contrast agent in noninvasive diagnosis of coronary artery disease

Coron Artery Dis. 2024 Dec 2. doi: 10.1097/MCA.0000000000001448. Online ahead of print.

Authors

Zengkun Wang^{1

2}, Xiaomei Luan^{1

2}, Qian Zhang³, Chu Chu^{2

4}, Xiaodie Xu^{1

2}, Huijing Chai^{2

4}, Peiji Song²

Affiliations

¹ School of Medical Imaging, Shandong Second Medical University, Weifang City.
² Department of Radiology.
³ Digestive Endoscopy Center, Central Hospital Affiliated to Shandong First Medical University and.
⁴ Graduate Department, Shandong First Medical University, Jinan, Shandong Province, China.

PMID: 39620884
DOI: 10.1097/MCA.0000000000001448

Abstract

Aim: The study aimed, using invasive coronary angiography (ICA) as the gold standard, to investigate the noninvasive diagnostic value of flow reserve fraction derived from coronary computed tomography angiography (CCTA) with low-dose contrast agent in coronary artery disease (CAD).

Methods: A total of 163 patients with clinical symptoms related to CAD were enrolled between 1 January 2022 and 30 January 2023. The patients received CCTA with a low dose of contrast agent to rule out CAD. If significant (CCTA ≥ 50%) stenosis is suspected, ICA is performed to further evaluate the CCTA for coronary lesions. CT-FFR is calculated from the CCTA dataset using a machine learning-based algorithm. Compared with ICA as a reference standard, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of low-dose contrast agent CT-FFR in the diagnosis of myocardial ischemia were calculated. Coronary lesions with CT-FFR ≤0.80 were defined as hemodynamically significant.

Results: Obstructive CAD was excluded by low-contrast CCTA in 87 of 163 patients (53.7%). In the remaining 75 patients (42.35%), at least one coronary artery stenosis was greater than 50%. The accuracy, sensitivity, specificity, PPV, and NPV of low-dose contrast agent CT-FFR on a patient-based evaluation in diagnosing CAD were 93.06, 93.44, 90.01, 98.28, and 71.43%, respectively (Kappa = 0.759). The accuracy, sensitivity, specificity, PPV, and NPV of low-dose contrast agent CT-FFR on a vessel-based evaluation in diagnosing CAD were 86.72, 82.76, 91.58, 92.31, and 81.31%, respectively (Kappa = 0.735). Pearson correlation analysis showed that the ICA examination had a good correlation with CT-FFR value of low-dose contrast media (r = 0.731, P < 0.01). Moreover, in 81.31% of cases, additional analysis of CT-FFR correctly excluded the hemodynamic significance of stenosis.

Conclusion: CT-FFR based on low-dose contrast agent CCTA is a very promising noninvasive approach to exclude hemodynamically significant coronary artery stenosis in patients with suspected coronary heart disease while reducing renal burden and helping to reduce the rate of ICA in this high-risk population.

Abstract

Grants and funding