Predictive value of coronary computed tomography-derived fractional flow reserve for coronary artery disease

Du Tianjian; Gu Xiang; Zhu Ye

doi:10.3969/j.issn.1009-0126.2024.09.002

Abstract：Objective To explore the predictive value of the fractional flow reserve derived from coronary computed tomography(FFRCT)in CAD.Methods Clinical data of 136 patients(309 ma-jor coronary vessels)with suspected CAD consecutively attending to Northern Jiangsu People's Hospital from January 2020 to February 2022 were collected and retrospectively analyzed.Coro-nary computed tomography angiography(CCTA)and coronary angiography(CAG)data and FFRCT were collected.The accuracy,positive predictive value,negative predictive value,sensitivity and specificity of CCTA and FFRCT for the diagnosis of stenosis in 309 major coronary arteries were compared;the correlation between FFRCT and CAG was analyzed using the consistency test.Imaging parameters of 156 vessels were analyzed by senior radiologists for smallest luminal diam-eter,stenotic plaque length,stenotic diameter rate,stenotic area rate,stenotic lumen area and plaque properties.The 98 vessels with ≥50％coronary stenosis were assigned into the coronary group,and the 58 vessels with＜50％ischaemic stenosis were into the non-coronary group.Logistic regression was used to analyze the relationship between the vessel parameters of 156 ves-sels and coronary heart disease(CHD);ROC curve was plotted to analyze the value of each pa-rameter and their combination for the diagnosis of CHD.Results The diagnostic efficacy of FFRCT was more accurate than that of CCTA for CAD(P＜0.01),and the Kappa agreement anal-ysis showed that the Kappa value of the diagnostic results of FFRCT and CAG was 0.620,indica-ting high agreement(P＜0.01).Lower smallest luminal diameter,lower FFRCT,longer stenotic plaque length,and higher diameter stenosis rate and area stenosis rate were observed in the coro-nary group than the non-coronary group(P＜0.01).Multivariate logistic regression analysis showed that smallest luminal diameter(OR=0.536,95％CI:0.335-0.858),stenotic plaque length(OR=1.109,95％CI:1.054-1.166),and FFRCT≤0.80(OR=0.204,95％CI:0.078-0.532)were independent influencing factors in predicting CAD(P＜0.01).ROC curve analysis revealed that the AUC value of combined smallest luminal diameter,stenotic plaque length,and FFRCT 0.80 together in diagnosis of CAD was 0.853(0.795-0.918).Conclusion FFRCT has a higher di-agnostic value for CAD than CCTA,and the combined diagnosis of FFRCT≤0.80,smallest luminal diameter,and stenotic plaque length can further improve the accuracy of the diagnosis of CAD.