Study on the application value of coronary CT angiography and fractional flow reserve in the evaluation of myocardial ischemia

Liu Tian; Zhang Jiaqi; Huang Bo; Chen Xiahuan; Gao Hai; Liu Meilin

doi:10.3760/j.issn.1673-4777.2025.12.001

Abstract：Objective To investigate the clinical value of coronary CT angiography(CCTA)and CT fractional flow reserve(CT-FFR)in the evaluation of myocardial ischemia caused by coronary artery disease.Methods A total of 106 patients with coronary atherosclerotic heart disease who underwent coronary angiography and fractional flow reserve(FFR)measurement at Peking University First Hospital from January 2018 to December 2022 were enrolled retrospectively.A total of 114 coronary vessels with 50％to 89％stenosis were included.All patients underwent CCTA examination within 3 months before surgery to obtain coronary disease reporting and data system(CAD-RADS)grades and CT-FFR values,and quantitative flow ratio(QFR)was calculated based on coronary angiography images.FFR≤0.80 was used as the diagnostic criterion for myocardial ischemia,and the diagnostic efficacy of each index was evaluated,and Spearman correlation and subgroup analysis were performed.Results The area under the curve(AUC)of CAD-RADS classification for the diagnosis of myocardial ischemia was 0.663(95％confidence interval:0.569-0.749).There was no correlation between CT-FFR and FFR(r=0.18,P=0.054),and the overall diagnostic efficacy of CT-FFR for myocardial ischemia was limited(AUC=0.562,95％confidence interval:0.466-0.655),but it showed better diagnostic performance in female patients(AUC=0.845)than in male patients(AUC=0.504,P＜0.001).QFR was highly correlated with FFR(r=0.82,P＜0.001),and the AUC for diagnosing myocardial ischemia was 0.965(95％confidence interval:0.913-0.991).Conclusion In patients with coronary artery stenosis ranging from 50％to 89％,QFR has high diagnostic consistency and accuracy,which can be used as a reference index to verify the accuracy of non-invasive assessment.CAD-RADS classification and CT-FFR alone have limited diagnostic value for functional myocardial ischemia.CT-FFR has a better diagnostic performance in female patients,suggesting that it may have certain application value in specific population.