CT-derived fractional flow reserve for anatomically long-segment coronary disease: a multicentre diagnostic accuracy study.
Authors
Affiliations (12)
Affiliations (12)
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China.
- Department of Cardiology, Beijing Anzhen Nanchong Hospital of Capital Medical University and Nanchong Central Hospital, Nanchong, China.
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China.
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China.
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, The Key Laboratory of Geriatrics of NHC; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
- Peking University Fifth School of Clinical Medicine, Beijing, China.
- Department of Radiology, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China. [email protected].
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, The Key Laboratory of Geriatrics of NHC; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China. [email protected].
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China. [email protected].
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China. [email protected].
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China. [email protected].
Abstract
To evaluate the diagnostic performance of CT-derived fractional flow reserve (CT-FFR) for detecting haemodynamically significant coronary disease in patients with anatomically long-segment lesions. This retrospective multicentre study included patients who underwent coronary CT angiography and invasive pressure-wire FFR within 30 days. Anatomically long-segment disease was defined as lesion length ≥ 20 mm. Invasive FFR ≤ 0.80 was the reference standard. CT-FFR was assessed at vessel and patient levels, with patient-level CT-FFR defined as the minimum value per patient and patient-level disease as any invasive FFR ≤ 0.80. Diagnostic discrimination, threshold-based classification, and Bland-Altman agreement were evaluated. The diagnostic cohort included 329 patients and 377 vessels; 137 patients and 144 vessels had anatomically long-segment disease. At the vessel level, CT-FFR achieved an AUC of 0.941 (95% CI: 0.917-0.966), sensitivity of 94.3%, specificity of 83.7%, and accuracy of 88.6%. In anatomically long-segment vessels, the AUC was 0.961 (95% CI: 0.922-1.000), with sensitivity of 95.7%, specificity of 92.2%, and accuracy of 94.4%. At the patient level, the overall AUC was 0.941 (95% CI: 0.915-0.967) and 0.971 (95% CI: 0.934-1.000) in anatomically long-segment disease. Mean bias was small, although limits of agreement were clinically relevant. CT-FFR showed high diagnostic discrimination for invasive FFR-defined ischaemia, including in anatomically long-segment disease. However, agreement limits and threshold-zone uncertainty support its use as a non-invasive physiological adjunct rather than a direct substitute for invasive pressure-wire assessment. Question Does machine learning-based CT-FFR maintain diagnostic performance for invasive FFR-defined ischaemia in anatomically long-segment coronary lesions? Findings CT-derived FFR showed high diagnostic discrimination overall and maintained performance in anatomically long-segment disease, although subgroup comparisons remained exploratory. Clinical relevance CT-derived FFR may provide non-invasive physiological information in anatomically long-segment coronary disease before invasive angiography, while values near the 0.80 threshold require cautious interpretation.