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Computed tomography derived fractional flow reserve (FFRCT) and computed tomography stress myocardial perfusion imaging (CTP) are techniques to assess haemodynamic significance of coronary stenosis. To compare the diagnostic performance of FFRCT and static rest/stress CTP in detecting fractional flow reserve (FFR) defined haemodynamically-significant stenosis (FFR <= 0.8). Fifty-one patients (96 vessels) with suspected coronary artery disease from a single institution planned for elective invasive-angiography prospectively underwent research indicated 320-detector-CT-coronary-angiography (CTA) and adenosine-stress CTP and invasive FFR. Analyses were performed in separate core-laboratories for FFRCT and CTP blinded to FFR results. Myocardial perfusion was assessed visually and semi-quantitatively by transmural perfusion ratio (TPR). Invasive FFR <= 0.8 was present in 33% of vessels and 49% of patients. FFRCT, visual CTP and TPR analysis was feasible in 96%, 92% and 92% of patients respectively. Overall per-vessel sensitivity, specificity and diagnostic accuracy for FFRCT were 81%, 85%, 84%, for visual CTP were 50%, 89%, 75% and for TPR were 69%, 48%, 56% respectively. Receiver-operating-characteristics curve analysis demonstrated larger per vessel area-under-curve (AUC) for FFRCT (0.89) compared with visual CTP (0.70; p < 0.001), TPR (0.58; p < 0.001) and CTA (0.70; p = 0.0007); AUC for CTA + FFRCT (0.91) was higher than CTA + visual CTP (0.77, p = 0.008) and CTA + TPR (0.74, p < 0.001). Per-patient AUC for FFRCT (0.90) was higher than visual CTP (0.69; p = 0.0016), TPR (0.56; p < 0.0001) and CTA (0.68; p = 0.001). Based on this selected cohort of patients FFRCT is superior to visually and semi-quantitatively assessed static rest/stress CTP in detecting haemodynamically-significant coronary stenosis as determined on invasive FFR.Copyright © 2019, The Author(s).

Background: Computed tomography derived fractional flow reserve (CT-FFR) and computed tomography stress myocardial perfusion imaging (CTP) are emerging techniques to assess the haemodynamic significance of coronary stenoses. Computation of CT-FFR using analysis conditions derived from structural deformation of coronary lumen and aorta and reduced order modelling has been recently described to be feasible. Comparison of diagnostic performance with visually assessed CTP is not known. Purpose(s): To compare the diagnostic performance of CT-FFR and CTP in detecting haemodynamically significant stenosis (FFR <=0.8), using invasive FFR as a reference standard. Method(s): Forty-three patients (77 vessels) with suspected coronary artery disease from a single institution planned for elective coronary angiography with invasive FFR prospectively underwent 320-detector coronary CTA and CTP. Analyses were performed in separate core laboratories for CT-FFR and CTP blinded to FFR results. For CT-FFR, deformation of coronary cross-sectional lumen and aorta, computed from diastolic CTA images, was used to determine analysis conditions based on hierarchical Bayes modelling. CT-FFR was derived using a reduced order model with dedicated software on a standard desktop computer. Myocardial perfusion was assessed visually by consensus of two interpreters. Result(s): Invasive FFR was significant in 24 (31%) vessels. CT-FFR and CTP analyses were feasible in 100% and 88% of vessels respectively. Overall pervessel sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for CT-FFR were 79%, 85%, 70%, 90%, 83% respectively and those of CTP were 50%, 91%, 75%, 77% and 77% respectively. Among the 12 false negative vessels in CTP, FFR range was 0.65-0.80. ROC curve analysis showed a significantly larger AUC for CT-FFR (0.89) compared with that for CTP (0.71; p=0.02). Conclusion(s): Based on this cohort of patients CT-FFR is superior to CTP in detectin

Aims To compare the diagnostic performance of a reduced-order computed tomography-derived fractional flow reserve (CT-FFR) technique derived from luminal deformation and static CT stress myocardial perfusion (CTP). Methods and results Forty-six patients (84 vessels) with suspected coronary artery disease from a single institution planned for elective coronary angiography prospectively underwent research indicated invasive fractional flow reserve (FFR) and 320-detector CT coronary angiography (CTA) and static CTP. Analyses were performed in separate blinded core laboratories for CT-FFR and CTP. CT-FFR was derived using a reduced-order model with dedicated software on a standard desktop computer. CTP was assessed visually and quantitatively by transmural perfusion ratio (TPR). Invasive FFR was significant in 33% (28/84) of vessels. Overall per-vessel sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for CT-FFR were 81%, 84%, 71%, 90%, and 83%, respectively, those of visual CTP were 54%, 92%, 79%, 77%, and 78%, respectively, and TPR were 64%, 48%, 42%, 70%, and 54%, respectively. Per-vessel receiver operator curve analysis demonstrated a significantly larger area under the curve (AUC) for CT-FFR (0.89) with that for visual CTP (0.72; P = 0.016), TPR (0.55; P < 0.0001), and CTA (0.76; P = 0.04). The addition of CT-FFR to CTA provided superior improvement in performance (AUC 0.93; P < 0.0001) compared with CTA alone, a combination of CTA with visual CTP (AUC 0.82; P = 0.007) and CTA with TPR (AUC 0.78; P = 0.0006). Conclusion Based on this selected cohort of patients, a reduced-order CT-FFR technique is superior to visual and quantitatively assessed static CTP in detecting haemodynamically significant coronary stenosis as assessed by invasive FFR. All rights reserved.Copyright © The Author(s) 2018.

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