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Jesper Møller Jensen

Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registry

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

DOI

  • Hidenobu Takagi, Tohoku University, University of British Columbia, Iwate Medical University
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  • Jonathon A Leipsic, University of British Columbia
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  • Noah McNamara, University of British Columbia
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  • Isabella Martin, University of British Columbia
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  • Timothy A Fairbairn, University of Liverpool
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  • Takashi Akasaka, Wakayama Medical University
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  • Bjarne L Nørgaard
  • Daniel S Berman, Cedars Sinai Heart Institute
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  • Kavitha Chinnaiyan, Division of Cardiology, Beaumont Academic Heart and Vascular Group, Royal Oak, Michigan.
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  • Lynne M Hurwitz-Koweek, Duke University
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  • Gianluca Pontone, Centro Cardiologico Monzino, Milan
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  • Tomohiro Kawasaki, Qatar Cardiovascular Research Center
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  • Niels Peter Rønnow Sand, University of Southern Denmark
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  • Jesper M Jensen
  • Tetsuya Amano, Aichi Medical University
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  • Michael Poon, Department of Noninvasive Cardiac Imaging, Northwell Health, New York, New York.
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  • Kristian A Øvrehus, University of Southern Denmark
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  • Jeroen Sonck, Cardiovascular Center Aalst, University of Naples Federico II
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  • Mark G Rabbat, Loyola University Chicago
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  • Sarah Mullen, Heartflow Inc.
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  • Bernard De Bruyne, Cardiovascular Center Aalst, University of Lausanne
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  • Campbell Rogers, Heartflow Inc.
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  • Hitoshi Matsuo, Gifu Heart Center
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  • Jeroen J Bax, Leiden University
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  • Pamela S Douglas, Duke University
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  • Manesh R Patel, Duke University
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  • Koen Nieman, Stanford University
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  • Abdul Rahman Ihdayhid, University of Western Australia, University of British Columbia

BACKGROUND: The role of change in fractional flow reserve derived from CT (FFRCT) across coronary stenoses (ΔFFRCT) in guiding downstream testing in patients with stable coronary artery disease (CAD) is unknown.

OBJECTIVES: To investigate the incremental value of ΔFFRCT in predicting early revascularization and improving efficiency of catheter laboratory utilization.

MATERIALS: Patients with CAD on coronary CT angiography (CCTA) were enrolled in an international multicenter registry. Stenosis severity was assessed as per CAD-Reporting and Data System (CAD-RADS), and lesion-specific FFRCT was measured 2 ​cm distal to stenosis. ΔFFRCT was manually measured as the difference of FFRCT across visible stenosis.

RESULTS: Of 4730 patients (66 ​± ​10 years; 34% female), 42.7% underwent ICA and 24.7% underwent early revascularization. ΔFFRCT remained an independent predictor for early revascularization (odds ratio per 0.05 increase [95% confidence interval], 1.31 [1.26-1.35]; p ​< ​0.001) after adjusting for risk factors, stenosis features, and lesion-specific FFRCT. Among the 3 models (model 1: risk factors ​+ ​stenosis type and location ​+ ​CAD-RADS; model 2: model 1 ​+ ​FFRCT; model 3: model 2 ​+ ​ΔFFRCT), model 3 improved discrimination compared to model 2 (area under the curve, 0.87 [0.86-0.88] vs 0.85 [0.84-0.86]; p ​< ​0.001), with the greatest incremental value for FFRCT 0.71-0.80. ΔFFRCT of 0.13 was the optimal cut-off as determined by the Youden index. In patients with CAD-RADS ≥3 and lesion-specific FFRCT ≤0.8, a diagnostic strategy incorporating ΔFFRCT >0.13, would potentially reduce ICA by 32.2% (1638-1110, p ​< ​0.001) and improve the revascularization to ICA ratio from 65.2% to 73.1%.

CONCLUSIONS: ΔFFRCT improves the discrimination of patients who underwent early revascularization compared to a standard diagnostic strategy of CCTA with FFRCT, particularly for those with FFRCT 0.71-0.80. ΔFFRCT has the potential to aid decision-making for ICA referral and improve efficiency of catheter laboratory utilization.

Original languageEnglish
JournalJournal of Cardiovascular Computed Tomography
Volume16
Issue1
Pages (from-to)19-26
Number of pages8
ISSN1934-5925
DOIs
Publication statusPublished - Jan 2022

    Research areas

  • Coronary artery disease (CAD), Coronary computed tomography angiography (CCTA), Fractional flow reserve (FFR), Fractional flow reserve derived from coronary computed tomography (FFR ), Severity of Illness Index, Predictive Value of Tests, Humans, Male, Tomography, X-Ray Computed, Computed Tomography Angiography, Coronary Artery Disease/diagnostic imaging, Coronary Angiography, Coronary Stenosis/diagnostic imaging, Fractional Flow Reserve, Myocardial, Female, Registries, Coronary Vessels/diagnostic imaging

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