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Computed tomography fractional flow reserve: impact of a new workstation based technique in the diagnostic workflow of stable coronary artery disease
Session:
CO6 - Imagiologia Cardiovascular
Speaker:
Pedro Ribeiro Queirós
Congress:
CPC 2019
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Pedro Ribeiro Queirós; Nuno Dias Ferreira; Ricardo Ladeiras-Lopes; Rita Faria; Cláudio Guerreiro; Marisa Passos Silva; Mónica Carvalho; Wilson Rua; Pedro Braga
Abstract
<p><strong><strong>Introduction</strong></strong></p> <p>Computed tomography coronary angiography (CTCA) is frequently used in the early evaluation of patients with suspected coronary artery disease (CAD), providing high diagnostic accuracy. The addition of functional assessment with fractional flow reserve derived from computed tomography (CT-FFR) has demonstrated incremental diagnostic value to CTCA alone in large-scale multicenter studies, thereby reducing the frequency of unnecessary invasive coronary angiography (ICA). CT-FFR is typically performed off-site using a super-computer, being associated with significant costs and a delay in the delivery of results. Recently, new methods were introduced, allowing independent on-site computation of FFR using regular workstations. Our aim was to determine the impact of the addition of CT-FFR to standard CTA in the management of patients with obstructive CAD, using an on-site software.</p> <p> </p> <p><strong><strong>Methods</strong></strong></p> <p>Patients referred to elective ICA having previously undergone CTCA for suspected stable CAD were retrospectively identified from September 2017 to November 2018. Patients with known CAD or Agatston score ≥1000 were excluded from analysis. Vessel-specific CT-FFR was computed using a workstation-based prototype software. Per-patient diagnostic accuracy of CT-FFR (positive if ≤0.8) for detection of hemodynamically significant CAD (defined in ICA as stenosis >90%, FFR ≤0.8 or iFR ≤0.9) was determined.</p> <p> </p> <p><strong><strong>Results</strong></strong></p> <p>From the 69 identified patients, CT-FFR was technically feasible in 60 patients (87,0%), with reasonable or high confidence in 80% of cases. Mean age was 60.4±11.4 with 78% of male individuals. Median time between CTCA and ICA was 43 days. Twenty-five patients (42%) had hemodynamically significant CAD. CT-FFR was positive in 35 patients (58%), showing a sensitivity and specificity of 76% (95% CI: 55-91%) and 54% (95% CI: 37-71%), respectively, for the diagnosis of significant CAD (AUC of 0.65, 95% CI 0.53-0.77). CT-FFR correctly classified 63% of patients and would avoid performing invasive coronary angiography in 19 patients (32%).</p> <p> </p> <p><strong><strong>Conclusion</strong></strong></p> <p>Workstation-based CT-FFR is a broadly feasible technique. Its addition to the diagnostic workflow of CAD, in patients whose CTCA results would require additional testing, can significantly improve the detection of hemodynamically significant CAD, without added radiation or relevant time delays.</p>
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