Comparison of Computed Tomography derived Fractional Flow Reserve to invasive Fractional Flow Reserve in Diagnosis of Functional Coronary Stenosis: A Meta-Analysis

• Type of Material: Article
• Authors: Pradyumna Agasthi, Mayo Clinic Arizona; Arun Kanmanthareddy, University of Texas Houston; Charl Khalil, Mayo Clinic Arizona; Obiora Egbuche, Morehouse School of Medicine; Vivek Yarlagadda, Atlanticare Regional Medical Center; Rajesh Sachdeva, Emory University; Reza Arsanjani, Mayo Clinic Arizona
• Language: English
• Date: 2018-08-01
• Publisher: NATURE PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2018
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1038/s41598-018-29910-9
• Title of Journal or Parent Work: SCIENTIFIC REPORTS
• Volume: 8
• Issue: 1
• Start Page: 11535
• End Page: 11535
• Keywords: Multidisciplinary Sciences; CT ANGIOGRAPHY DATA; Science & Technology; BLOOD-FLOW; Science & Technology - Other Topics; ARTERY-DISEASE; INTERMEDIATE STENOSIS; GUIDED PCI; ACCURACY; CONTROLLED-TRIAL; PERFORMANCE; CLINICAL-PRACTICE; FOLLOW-UP
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Computed Tomography derived Fractional Flow Reserve (CTFFR) is an emerging non-invasive imaging modality to assess functional significance of coronary stenosis. We performed a meta-analysis to compare the diagnostic performance of CTFFR to invasive Fractional Flow reserve (FFR). Electronic search was performed to identify relevant articles. Pooled Estimates of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-) and diagnostic odds ratio (DOR) with corresponding 95% confidence intervals (CI) were calculated at the patient level as well as the individual vessel level using hierarchical logistic regression, summary receiver operating characteristic (SROC) curve and area under the curve were estimated. Our search yielded 559 articles and of these 17 studies was included in the analysis. A total of 2,191 vessels in 1294 patients were analyzed. Pooled estimates of sensitivity, specificity, LR+, LR- and DOR with corresponding 95% CI at per-patient level were 83% (79-87), 72% (68-76), 3.0 (2.6-3.5), 0.23 (0.18-0.29) and 13 (9-18) respectively. Pooled estimates of sensitivity, specificity, LR+, LR- and DOR with corresponding 95% CI at per-vessel level were 85% (83-88), 76% (74-79), 3.6 (3.3-4.0), 0.19 (0.16-0.22) and 19 (15-24). The area under the SROC curve was 0.89 for both per patient level and at the per vessel level. In our meta-analysis, CTFFR demonstrated good diagnostic performance in identifying functionally significant coronary artery stenosis compared to the FFR.