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

Abstract

We aimed to compare the performance of FFR_CT and FFR_QCA in assessing the functional significance of coronary artery stenosis in patients suffering from coronary artery disease with stable angina. A total of 101 stable coronary heart disease (CAD) patients with 181 lesions were recruited. FFR_CT and FFR_QCA were compared using invasive fractional flow reserve (FFR) as a reference standard. Comparisons between FFR_CT and FFR_QCA were conducted based on strategies of the geometric reconstruction, boundary conditions, and geometric characteristics. The performance of FFR_CT and FFR_QCA in detecting hemodynamic significance was also investigated. The performance of FFR_CT and FFR_QCA in discriminating hemodynamically significant lesions was compared. Good correlation and agreement with invasive FFR was found using FFR_CT and FFR_QCA (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 FFR_CT than FFR_QCA when analyzing the stenosis distributed in the middle segment of a stenotic branch (p = 0.036). Moreover, FFR_CT was found to be better at predicting hemodynamically insignificant stenosis than FFR_QCA (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. FFR_CT and FFR_QCA could both accurately rule out functional insignificant lesions in stable CAD patients. FFR_CT was found to be better for the noninvasive screening of CAD patients with stable angina than FFR_QCA. • FFR _CT and FFR _QCA were both in good correlation and agreement with invasive FFR measurements. • FFR _CT is superior in accuracy and consistency compared to FFR _QCA in patients with stenoses distributed in left coronary artery. • The noninvasive nature of FFR _CT could provide potential benefit for stable CAD patients on disease management.