Original Research

DOI: 10.4244/EIJ-D-24-00336

Accuracy of coronary computed tomography angiography-derived quantitative flow ratio for onsite assessment of coronary lesions

Tingwen Weng1, MD; Daixin Ding2, PhD; Guanyu Li3, BSc; Shaofeng Guan1, MD, PhD; Wenzheng Han1, MD, PhD; Qian Gan1, MD, PhD; Ming Li4, MD, PhD; Lin Qi4, MD, PhD; Cheng Li4, MD; Yang Chen1, MD; Liang Zhang1, MD; Tianqi Li1, MD, PhD; Xifeng Chang1, MD; Yankai Chen3, BSc; William Wijns5, MD, PhD; Xinkai Qu1, MD, PhD; Shengxian Tu3, PhD

Abstract

BACKGROUND: Coronary computed tomography angiography (CCTA)-derived Murray law-based quantitative flow ratio (CT-μFR) is a novel non-invasive method for fast computation of fractional flow reserve (FFR) from CCTA images, yet its diagnostic performance remains to be prospectively validated.

AIMS: We aimed to evaluate the diagnostic performance of onsite CT-μFR in patients with coronary artery disease.

METHODS: This prospective, single-centre trial enrolled patients with ≥1 lesion with 30-90% diameter stenosis on CCTA and planned invasive coronary angiography (ICA) within 30 days. CT-μFR, ICA-derived μFR and FFR were evaluated separately in a blinded fashion. The primary endpoint was the diagnostic accuracy of CT-μFR in identifying patients with haemodynamically significant coronary stenosis defined by the invasive standard: FFR ≤0.80, or μFR ≤0.80 when FFR was not available.

RESULTS: Between December 2020 and August 2023, 260 patients were consecutively enrolled. Paired comparison between CT-μFR and the invasive standard was obtained in 706 vessels from 260 patients. The patient-level accuracy of CT-μFR was 89.6% (95% confidence interval [CI]: 85.9-93.4%), which was significantly higher than the prespecified target of 72.0% (p<0.001). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios for CT-μFR were 93.1%, 86.1%, 87.1%, 92.5%, 6.7, and 0.1, respectively. Out of the 231 vessels investigated by FFR, the accuracy of CT-μFR in vessels without extensive calcification was non-inferior to that of μFR (90.6% vs 88.9%; difference=1.8% [95% CI: −2.8 to 5.5%]; p for non-inferiority<0.001).

CONCLUSIONS: The study met its prespecified primary endpoint of the diagnostic accuracy of CT-μFR in identifying patients with haemodynamically significant coronary stenosis. CT-μFR was non-inferior to ICA-derived μFR in vessels without extensive calcification. (ClinicalTrials.gov: NCT04665817)

Sign in to read
the full article

Forgot your password?
No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

Volume 20 Number 20
Oct 21, 2024
Volume 20 Number 20
View full issue


Key metrics

Suggested by Cory

Clinical Research

10.4244/EIJ-D-21-00471 Apr 22, 2022
Vessel fractional flow reserve (vFFR) for the assessment of stenosis severity: the FAST II study
Masdjedi K et al
free

Editorial

10.4244/EIJ-E-23-00031 Aug 7, 2023
Quantitative flow ratio and cardiovascular risk: paralleling the FFR ischaemic continuum
Kern M
free

10.4244/EIJV9I2A44 Jun 28, 2013
Virtual fractional flow reserve by coronary computed tomography - hope or hype?
Rajani R et al
free

10.4244/EIJV11SVA11 May 19, 2015
Image-based assessment of fractional flow reserve
Tu S et al
free
Trending articles
69.996

10.4244/EIJV13I12A217 Dec 8, 2017
Swimming against the tide: insights from the ORBITA trial
Al-Lamee R and Francis D
free
60.9

State-of-the-Art

10.4244/EIJ-D-24-00066 Apr 21, 2025
Management of complications after valvular interventions
Bansal A et al
free
57.35

State-of-the-Art

10.4244/EIJ-D-24-00386 Feb 3, 2025
Mechanical circulatory support for complex, high-risk percutaneous coronary intervention
Ferro E et al
free
38.75

State-of-the-Art

10.4244/EIJ-D-23-00912 Oct 7, 2024
Optical coherence tomography to guide percutaneous coronary intervention
Almajid F et al
free
15.85

State-of-the-Art

10.4244/EIJ-D-23-01050 Jul 15, 2024
Durability of transcatheter aortic valve implantation
Ternacle J et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 7.6
2023 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2024)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2025 Europa Group - All rights reserved