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Zhang L, Xie D, Gan Y, Zhang Z, Wang Y, Xie J, Zhang B, Kou Z, Zhang Y, Li B, Kou X, Mao R, Jin J, Liang T, Li S. Clinical value of fractional flow reserve in coronary heart disease: A retrospective study. Medicine (Baltimore) 2024; 103:e40644. [PMID: 39686458 PMCID: PMC11651491 DOI: 10.1097/md.0000000000040644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 11/05/2024] [Indexed: 12/18/2024] Open
Abstract
This study investigated the clinical value of coronary arteriography (CAG) combined with fractional flow reserve (FFR) in the treatment of coronary heart disease (CHD) with coronary artery stenosis exceeding 70%. A retrospective analysis was conducted on 344 patients with CHD treated at the Gansu Institute of Cardiovascular Science from January 2020 to May 2022. The patients were divided into the CAG group (n = 138) and the CAG + FFR group (n = 206). Among these patients, those with coronary artery stenosis exceeding 70% underwent an FFR functional examination to accurately determine indicators for coronary intervention. The data collected included demographic information, number of stents, number of vascular lesions, treatment methods, and the occurrence of major adverse cardiovascular events (MACE) at the 6-month follow-up. No significant differences were found between the 2 groups in terms of age, gender, underlying diseases, body mass index (BMI), smoking history, and blood lipid profile. The rate of surgical treatment in the CAG group and the CAG + FFR group was 88.41% and 43.69%, respectively. The CAG + FFR group showed a 44.72% reduction in the need for surgical treatment and a reduced number of stents placed, which helped prevent overtreatment. Additionally, there was no statistical difference between the 2 groups in MACE such as angina pectoris, myocardial infarction, and sudden cardiac death at the 6-month follow-up. After combined CAG examination with FFR measurement, the number of CHD patients with coronary artery stenosis exceeding 70% requiring surgical intervention decreased by 44.72%. FFR could significantly prevent overtreatment and provide more precise guidance for CHD treatments.
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Affiliation(s)
- Liying Zhang
- Gansu Institute of Cardiovascular Diseases, Lanzhou, China
| | - Dingxiong Xie
- Gansu Institute of Cardiovascular Diseases, Lanzhou, China
| | - Yirong Gan
- Gansu Institute of Cardiovascular Diseases, Lanzhou, China
| | - Zheng Zhang
- Department of Cardiovascular Medicine, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yanzhen Wang
- Gansu Institute of Cardiovascular Diseases, Lanzhou, China
| | - Jing Xie
- Department of Ultrasound, The First People’s Hospital of Lanzhou, Lanzhou, China
| | - Bo Zhang
- Department of Cardiovascular Medicine, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zongke Kou
- Gansu Institute of Cardiovascular Diseases, Lanzhou, China
| | - Yunlong Zhang
- Gansu Institute of Cardiovascular Diseases, Lanzhou, China
| | - Bing Li
- Gansu Institute of Cardiovascular Diseases, Lanzhou, China
| | - Xiaoqing Kou
- Gansu Institute of Cardiovascular Diseases, Lanzhou, China
| | - Rui Mao
- Gansu Institute of Cardiovascular Diseases, Lanzhou, China
| | - Jianjian Jin
- Department of Cardiovascular Medicine, The First Hospital of Lanzhou University, Lanzhou, China
| | | | - Sheng Li
- Department of General Surgery, Lanzhou First People’s Hospital, Lanzhou, China
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Žuža I, Nadarević T, Jakljević T, Bartolović N, Kovačić S. The Effect of Severe Coronary Calcification on Diagnostic Performance of Computed Tomography-Derived Fractional Flow Reserve Analyses in People with Coronary Artery Disease. Diagnostics (Basel) 2024; 14:1738. [PMID: 39202227 PMCID: PMC11353250 DOI: 10.3390/diagnostics14161738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/04/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Negative CCTA can effectively exclude significant CAD, eliminating the need for further noninvasive or invasive testing. However, in the presence of severe CAD, the accuracy declines, thus necessitating additional testing. The aim of our study was to evaluate the diagnostic performance of noninvasive cFFR derived from CCTA, compared to ICA in detecting hemodynamically significant stenoses in participants with high CAC scores (>400). METHODS This study included 37 participants suspected of having CAD who underwent CCTA and ICA. CAC was calculated and cFFR analyses were performed using an on-site machine learning-based algorithm. Diagnostic accuracy parameters of CCTA and cFFR were calculated on a per-vessel level. RESULTS The median total CAC score was 870, with an IQR of 642-1370. Regarding CCTA, sensitivity and specificity for RCA were 60% and 67% with an AUC of 0.639; a LAD of 87% and 50% with an AUC of 0.688; an LCX of 33% and 90% with an AUC of 0.617, respectively. Regarding cFFR, sensitivity and specificity for RCA were 60% and 61% with an AUC of 0.606; a LAD of 75% and 54% with an AUC of 0.647; an LCX of 50% and 77% with an AUC of 0.647. No significant differences between AUCs of coronary CTA and cFFR for each vessel were found. CONCLUSIONS Our results showed poor diagnostic accuracy of CCTA and cFFR in determining significant ischemia-related lesions in participants with high CAC scores when compared to ICA. Based on our results and study limitations we cannot exclude cFFR as a method for determining significant stenoses in people with high CAC. A key issue is accurate and detailed lumen segmentation based on good-quality CCTA images.
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Affiliation(s)
- Iva Žuža
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia; (T.N.); (N.B.); (S.K.)
| | - Tin Nadarević
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia; (T.N.); (N.B.); (S.K.)
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
| | - Tomislav Jakljević
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
- Clinic for Heart and Vessel Diseases, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia
| | - Nina Bartolović
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia; (T.N.); (N.B.); (S.K.)
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
| | - Slavica Kovačić
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia; (T.N.); (N.B.); (S.K.)
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
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Faulder TI, Prematunga K, Moloi SB, Faulder LE, Jones R, Moxon JV. Agreement of Fractional Flow Reserve Estimated by Computed Tomography With Invasively Measured Fractional Flow Reserve: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2024; 13:e034552. [PMID: 38726901 PMCID: PMC11179792 DOI: 10.1161/jaha.124.034552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/21/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Fractional flow reserve (FFR) is the ratio of blood pressure measured distal to a stenosis and pressure proximal to a stenosis. FFR can be estimated noninvasively using computed tomography (CT) although the usefulness of this technique remains controversial. This meta-analysis evaluated the agreement of FFR estimated by CT (FFR-CT) with invasively measured FFR. The study also evaluated the diagnostic accuracy of FFR-CT, defined as the ability of FFR-CT to classify lesions as hemodynamically significant (invasive FFR ≤0.8) or insignificant (invasive FFR >0.8). METHODS AND RESULTS Forty-three studies reporting on 7291 blood vessels from 5236 patients were included. A moderate positive linear relationship between FFR-CT and invasively measured FFR was observed (Spearman correlation coefficient: 0.67). Agreement between the 2 measures increased as invasively measured FFR values approached 1. The overall diagnostic accuracy, sensitivity and specificity of FFR-CT were 82.2%, 80.9%, and 83.1%, respectively. Diagnostic accuracy of 90% could be demonstrated for FFR-CT values >0.90 and <0.49. The diagnostic accuracy of off-site tools was 79.4% and the diagnostic accuracy of on-site tools was 84.1%. CONCLUSIONS The agreement between FFR-CT and invasive FFR is moderate although agreement is highest in vessels with FFR-CT >0.9. Diagnostic accuracy varies widely with FFR-CT value but is above 90% for FFR-CT values >0.90 and <0.49. Furthermore, on-site and off-site tools have similar performance. Ultimately, FFR-CT may be a useful adjunct to CT coronary angiography as a gatekeeper for invasive coronary angiogram.
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Affiliation(s)
- Thomas I Faulder
- College of Medicine and Dentistry James Cook University Townsville QLD Australia
| | | | - Soniah B Moloi
- Department of Cardiology Townsville University Hospital Townsville QLD Australia
| | - Lauren E Faulder
- College of Medicine and Dentistry University of Adelaide Adelaide SA Australia
| | - Rhondda Jones
- Graduate Research School James Cook University Townsville QLD Australia
- Tropical Australian Academic Health Centre James Cook University Townsville QLD Australia
| | - Joseph V Moxon
- College of Medicine and Dentistry James Cook University Townsville QLD Australia
- The Australian Institute of Tropical Health and Medicine James Cook University Townsville QLD Australia
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Zhang X, Zhu X, Jiang Y, Wang H, Guo Z, Du B, Hu Y. Science mapping analysis of computed tomography-derived fractional flow reverse: a bibliometric review from 2012 to 2022. Quant Imaging Med Surg 2023; 13:5605-5621. [PMID: 37711816 PMCID: PMC10498214 DOI: 10.21037/qims-22-1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 06/27/2023] [Indexed: 09/16/2023]
Abstract
Background Computed tomography-derived fractional flow reserve (CT-FFR) is a non-invasive imagological examination used for diagnosing suspected coronary atherosclerotic heart disease, providing the morphological and functional value on a three-dimensional (3D) coronary artery model. This article aimed to collate the existing knowledge and predict this novel technology's future research hotspots. Methods To collect data, 1,712 articles were retrieved from the Web of Science Core Collection (WoSCC) database from 2012-2022. CiteSpace5.8.R3 was used to visually analyze the research status and predict future research hotspots. Results Firstly, the United States, China, and the Netherlands were identified as the countries having published the most articles about CT-FFR. Jonathan Leipsic's group ranked first for the highest number of published articles. Secondly, the visualized analysis indicated that the exploration of CT-FFR is multi-disciplinary and involves cardiology, radiology, engineering, and computer science. Thirdly, the hotspots in this field, which were inferred from the keyword distribution and clustering, included the following: "diagnostic performance", "accuracy", and the "prognostic value" of CT-FFR, and comparison of CT-FFR and other imaging methods sharing similarities. The research frontiers included technologies utilized to obtain more accurate CT-FFR values, such as artificial intelligence (AI) and deep learning. Conclusions As the first visualized bibliometric analysis on CT-FFR, this study captured the current accumulated information in this field and offer more insight and guidance for future research.
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Affiliation(s)
- Xiaohan Zhang
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xueping Zhu
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuchen Jiang
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huan Wang
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zezhen Guo
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Bai Du
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanhui Hu
- Department of Cardiovascular Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Oikonomou E, Theofilis P, Lampsas S, Katsarou O, Kalogeras K, Marinos G, Tsatsaragkou A, Anastasiou A, Lysandrou A, Gounaridi MI, Gialamas I, Vavuranakis MA, Tousoulis D, Vavuranakis M, Siasos G. Current Concepts and Future Applications of Non-Invasive Functional and Anatomical Evaluation of Coronary Artery Disease. Life (Basel) 2022; 12:1803. [PMID: 36362957 PMCID: PMC9696378 DOI: 10.3390/life12111803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Over the last decades, significant advances have been achieved in the treatment of coronary artery disease (CAD). Proper non-invasive diagnosis and appropriate management based on functional information and the extension of ischemia or viability remain the cornerstone in the fight against adverse CAD events. Stress echocardiography and single photon emission computed tomography are often used for the evaluation of ischemia. Advancements in non-invasive imaging modalities such as computed tomography (CT) coronary angiography and cardiac magnetic resonance imaging (MRI) have not only allowed non-invasive imaging of coronary artery lumen but also provide additional functional information. Other characteristics regarding the plaque morphology can be further evaluated with the latest modalities achieving a morpho-functional evaluation of CAD. Advances in the utilization of positron emission tomography (PET), as well as software advancements especially regarding cardiac CT, may provide additional prognostic information to a more evidence-based treatment decision. Since the armamentarium on non-invasive imaging modalities has evolved, the knowledge of the capabilities and limitations of each imaging modality should be evaluated in a case-by-case basis to achieve the best diagnosis and treatment decision. In this review article, we present the most recent advances in the noninvasive anatomical and functional evaluation of CAD.
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Affiliation(s)
- Evangelos Oikonomou
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Panagiotis Theofilis
- 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece
| | - Stamatios Lampsas
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Ourania Katsarou
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Georgios Marinos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Aikaterini Tsatsaragkou
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Artemis Anastasiou
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Antonios Lysandrou
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Maria-Ioanna Gounaridi
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Ioannis Gialamas
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Michael-Andrew Vavuranakis
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
- Cardiovascular Division, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA 02115, USA
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