Background: The application of coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) is limited due to severe coronary calcium burden or stent implantation. This study aimed to explore the diagnostic value of subtraction CT-FFR with deep learning reconstruction (DLR) or hybrid iterative reconstruction (HIR) in detecting calcified-related hemodynamically significant stenosis, and the feasibility in the application of coronary stents.
Methods: Between March 2020 and January 2022, consecutive patients with calcified-related stenosis or previous stent treatment who had undergone subtraction coronary computed tomography angiography (CTA) and invasive fractional flow reserve (FFR) were included in this prospective study. CT image data were reconstructed using HIR and DLR. The diagnostic performance of CT-FFR, and subtraction CT-FFR were evaluated. An FFR value of 0.8 or less was considered hemodynamically significant.
Results: A total of 30 patients with 52 calcified-related lesions and 14 coronary stents were included in this study. Subtraction CT-FFR outperformed the corresponding CT-FFR in detecting calcified-related hemodynamically significant stenosis and in the application of coronary stents, while there was no significant difference when subtraction CT-FFR was compared with subtraction CT-FFR (P>0.05). Lesion-based analysis showed the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for subtraction CT-FFR were 100.0%, 71.4%, 63.0%, 100% and 80.8%, respectively in detecting calcified-related hemodynamically significant stenosis, and were 100.0%, 83.3%, 88.9%, 100% and 92.9%, respectively in the application of coronary stents.
Conclusions: Subtraction CT-FFR yielded optimal diagnostic performance for hemodynamically significant calcified-related stenosis, and the application of subtraction CT-FFR in the evaluation of coronary stents was feasible. The diagnostic performance of subtraction CT-FFR was better than that of subtraction CT-FFR, but there was no significant difference.
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| http://dx.doi.org/10.21037/qims-24-1366 | DOI Listing |
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Article Synopsis
- On-site workstation-based CT fractional flow reserve (CT-FFR) shows promise for evaluating ischemia in coronary artery disease, but its effectiveness is hindered by severe calcification in blood vessels.
- The use of a subtraction method enhances diagnostic accuracy for patients with severe calcification, as evidenced by improved sensitivity, specificity, and predictive values when comparing subtraction CT-FFR to standard CT-FFR.
- In a study of 32 patients with severe calcification, subtraction CT-FFR demonstrated better overall diagnostic performance and reproducibility than CT-FFR, indicating its potential as a more reliable assessment tool.
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