Computed tomography angiography-derived fractional flow reserve (CT-FFR) for the detection of myocardial ischemia with invasive fractional flow reserve as reference: systematic review and meta-analysis

Objectives A method named computed tomography angiography-derived fractional flow reserve (FFR CT ) is an alternative method for detecting hemodynamically significant coronary stenosis. We carried out a meta-analysis to derive reliable assessment of the diagnostic performances of FFR CT and compare the diagnostic accuracy with CCTA using FFR as reference. Methods We searched PubMed, EMBASE, The Cochrane Library, and Web of science for relevant articles published from January 2008 until May 2019 using the following search terms: FFR CT , noninvasive FFR, non-invasive FFR, noninvasive fractional flow reserve, non-invasive fractional flow reserve, and CCTA. Pooled estimates of sensitivity and specificity with the corresponding 95% confidence intervals (CIs) and the summary receiver operating characteristic curve (sROC) were determined. Results Sixteen studies published between 2011 and 2019 were included with a total of 1852 patients and 2731 vessels. The pooled sensitivity and specificity for FFR CT at the per-patient level was 89% (95% CI, 85–92%) and 71% (95% CI, 61–80%), respectively, while on the per-vessel basis was 85% (95% CI, 82–88%) and 82% (95% CI, 75–87%), respectively. No apparent difference in the sensitivity at per-patient and per-vessel level between FFR CT and CCTA was observed (0.89 versus 0.93 at per-patient; 0.85 versus 0.88 at per-vessel). However, the specificity of FFR CT was higher than CCTA (0.71 versus 0.32 at per-patient analysis; 0.82 versus 0.46 at per-vessel analysis). Conclusions FFR CT obtained a high diagnostic performance and is a viable alternative to FFR for detecting coronary ischemic lesions. Key Points • Noninvasive FFR CT has higher specificity for anatomical and physiological assessment of coronary artery stenosis compared with CCTA. • Noninvasive FFR CT is a viable alternative to invasive FFR for the detection and exclusion of coronary lesions that cause ischemia.