Highlights
- •CTA-based plaque morphology predicts fractional flow reserve with high accuracy.
- •Sensitivity and specificity are on par compared to commercial CT-FFR derivation.
- •Plaque morphology predicts the continuous value of fractional flow reserve.
Abstract
Background
To evaluate the feasibility of non-invasive fractional flow reserve (FFR) estimation
using histologically-validated assessment of plaque morphology on coronary CTA (CCTA)
as inputs to a predictive model further validated against invasive FFR.
Methods
Patients (n = 113, 59 ± 8.9 years, 77% male) with suspected coronary artery disease
(CAD) who had undergone CCTA and invasive FFR between August 2013 and May 2018 were
included. Commercially available software was used to extract quantitative plaque
morphology inclusive of both vessel structure and composition. The extracted plaque
morphology was then fed as inputs to an optimized artificial neural network to predict
lesion-specific ischemia/hemodynamically significant CAD with performance validated
by invasive FFR.
Results
A total of 122 lesions were considered, 59 (48%) had low FFR values. Plaque morphology-based
FFR assessment achieved an area under the curve, sensitivity and specificity of 0.94,
0.90 and 0.81, respectively, versus 0.71, 0.71, and 0.50, respectively, for an optimized
threshold applied to degree of stenosis. The optimized ridge regression model for
continuous value estimation of FFR achieved a cross-correlation coefficient of 0.56
and regression slope of 0.59 using cross validation, versus 0.18 and 0.10 for an optimized
threshold applied to degree of stenosis.
Conclusions
Our results show that non-invasive plaque morphology-based FFR assessment may be used
to predict lesion-specific ischemia resulting in hemodynamically significant CAD.
This substantially outperforms degree of stenosis interpretation and has a comparable
level of sensitivity and specificity relative to publicly reported results from computational
fluid dynamics-based approaches.
Keywords
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Article info
Publication history
Published online: January 30, 2021
Accepted:
January 22,
2021
Received in revised form:
January 15,
2021
Received:
December 11,
2020
Footnotes
☆All author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
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- Non-invasive plaque morphology-based FFR assessment: A new approach to predict ischemic coronary artery disease?International Journal of CardiologyVol. 332
- PreviewCoronary artery disease (CAD) is one of the main causes of death globally and results in high health care costs. Because of this, there is an urgent need for improvement regarding precise diagnostics and further decision-making leading to invasive coronary angiography, revascularization, and reduction of related complications.
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