Jesper Møller Jensen

Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperReviewResearchpeer-review

  • Bjarne L Nørgaard
  • Sara Gaur
  • ,
  • Timothy A Fairbairn, Liverpool Heart and Chest Hospital NHS Foundation Trust
  • ,
  • Pam S Douglas, Duke University
  • ,
  • Jesper M Jensen
  • Manesh R Patel, Duke University
  • ,
  • Abdul R Ihdayhid, Monash University
  • ,
  • Brian S H Ko, Monash University
  • ,
  • Stephanie L Sellers, St. Pauls Hospital
  • ,
  • Jonathan Weir-McCall, University of Cambridge
  • ,
  • Hitoshi Matsuo, Gify Heart Center
  • ,
  • Niels Peter R Sand, University of Southern Denmark
  • ,
  • Kristian A Øvrehus, University of Southern Denmark
  • ,
  • Campbell Rogers, Heartflow Inc.
  • ,
  • Sarah Mullen, Heartflow Inc.
  • ,
  • Koen Nieman, Stanford University
  • ,
  • Erik Parner
  • Jonathon Leipsic, St. Pauls Hospital
  • ,
  • Jawdat Abdulla, Glostrup Hospital

OBJECTIVES: To obtain more powerful assessment of the prognostic value of fractional flow reserveCT testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed clinical outcomes of CT-derived calculation of FFR (FFRCT) (HeartFlow) analysis in patients with stable coronary artery disease (CAD).

METHODS: We searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserveCT testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as 'all-cause mortality (ACM) or myocardial infarction (MI)' at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint.

RESULTS: Five studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFRCT>0.80% and 1.4% (47/3334) with FFRCT ≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFRCT ≤0.80 versus patients with FFRCT >0.80. Each 0.10-unit FFRCT reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001).

CONCLUSIONS: The 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFRCT result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFRCT numerical value was inversely associated with outcomes.

Original languageEnglish
Pages (from-to)194-202
Number of pages9
Publication statusPublished - Feb 2022

    Research areas

  • CT ANGIOGRAPHY, DISEASE, OUTCOMES, SEVERITY, TRIALS, angina pectoris, computed tomography angiography, diagnostic imaging

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