Comparison of Diagnostic Accuracy of CT Derived Fractional Flow Reserve for Predicting Revascularization

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Abstract
Purpose: CT‐derived fractional‐flow‐reserve (FFRCT) is recommended for determining the indication of revascularization. Consensus on optimal fractional‐flow‐reserve (FFR) measurement methods and lesions is lacking. To investigate the diagnostic accuracy of FFRCT measurement methods for predicting revascularization and factors affecting FFRCT measurement methods.Methods: A total of 340 patients (382 vessels) who underwent CT angiography and showed ≥50% diameter stenosis (DS) on invasive coronary angiography were evaluated. Enrolled vessels were classified into four groups according to lesion length (focal, CT was measured at the distal end of the vessel (vessel‐distal FFRCT), distal to the stenotic lesion (lesion‐specific FFRCT), and trans‐lesion FFRCT (ΔFFRCT) and compared with DS. Vessel morphology and left ventricular mass were assessed.Results: In focal lesions, the predictive ability for revascularization of ΔFFRCT (AUC = 0.71) was comparable to that of DS (AUC = 0.76, p = 0.166) and higher than that of lesion‐specific FFRCT (AUC = 0.67, p < 0.001) and vessel‐distal FFRCT (AUC = 0.63, p < 0.001). Multivariable analysis showed that lesion length was the strongest predictor of ΔFFRCT (β‐coefficient = 0.42, p = 0.006). In diffuse lesions, the predictive ability for revascularization of ΔFFRCT (AUC = 0.73) was comparable to that of DS (AUC = 0.77, p = 0.667), lesion‐specific FFRCT (AUC = 0.72, p = 0.653), and vessel‐distal FFRCT (AUC = 0.69, p = 0.242). Multivariable analysis showed that lesion length was the strongest predictor of ΔFFRCT (β‐coefficient = 0.99, p < 0.001).Conclusion: The predictive performance of ΔFFRCT for revascularization was similar to DS in focal and diffuse lesions. ΔFFRCT was influenced by lesion length.

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