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Computed tomography derived fractional flow reserve (FFRCT) and computed tomography stress myocardial perfusion imaging (CTP) are techniques to assess haemodynamic significance of coronary stenosis. To compare the diagnostic performance of FFRCT and static rest/stress CTP in detecting fractional flow reserve (FFR) defined haemodynamically-significant stenosis (FFR <= 0.8). Fifty-one patients (96 vessels) with suspected coronary artery disease from a single institution planned for elective invasive-angiography prospectively underwent research indicated 320-detector-CT-coronary-angiography (CTA) and adenosine-stress CTP and invasive FFR. Analyses were performed in separate core-laboratories for FFRCT and CTP blinded to FFR results. Myocardial perfusion was assessed visually and semi-quantitatively by transmural perfusion ratio (TPR). Invasive FFR <= 0.8 was present in 33% of vessels and 49% of patients. FFRCT, visual CTP and TPR analysis was feasible in 96%, 92% and 92% of patients respectively. Overall per-vessel sensitivity, specificity and diagnostic accuracy for FFRCT were 81%, 85%, 84%, for visual CTP were 50%, 89%, 75% and for TPR were 69%, 48%, 56% respectively. Receiver-operating-characteristics curve analysis demonstrated larger per vessel area-under-curve (AUC) for FFRCT (0.89) compared with visual CTP (0.70; p < 0.001), TPR (0.58; p < 0.001) and CTA (0.70; p = 0.0007); AUC for CTA + FFRCT (0.91) was higher than CTA + visual CTP (0.77, p = 0.008) and CTA + TPR (0.74, p < 0.001). Per-patient AUC for FFRCT (0.90) was higher than visual CTP (0.69; p = 0.0016), TPR (0.56; p < 0.0001) and CTA (0.68; p = 0.001). Based on this selected cohort of patients FFRCT is superior to visually and semi-quantitatively assessed static rest/stress CTP in detecting haemodynamically-significant coronary stenosis as determined on invasive FFR.Copyright © 2019, The Author(s).

Introduction: Computed tomography derived fractional flow reserve (FFRCT) and computed tomography stress myocardial perfusion imaging (CTP) are techniques to assess the haemodynamic significance of coronary stenoses. Comparison of diagnostic performance of FFRCT with visually-assessed CTP is not known. Objective(s): To compare the diagnostic performance of FFRCT and CTP in detecting fractional flow reserve (FFR) defined haemodynamically significant stenosis (FFR<0.8). Method(s): Eighty-six patients (172 vessels) with suspected and known coronary artery disease from a single institution planned for elective coronary angiography with invasive FFR prospectively underwent 320-detector CT coronary angiogra-phy (CTA) and CTP. Retrospective analyses were performed in separate core laboratories for FFRCT and CTP blinded to FFR results. Myocardial perfusion was assessed visually by consensus of 2 interpreters. A stenosis is considered haemo-dynamically significant if FFRCT was <0.8, or the presence of perfusion defect in corresponding vessel. Result(s): Invasive FFR <0.8 was present in 55 (32%) vessels. FFRCT and CTP analyses were feasible in 97% and 88% of vessels respectively. Overall per-vessel sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for FFRCT were 79%, 82%, 67%, 89%, 81% respectively and those of CTP were 43%, 90%, 70%, 75% and 74% respectively. Among the 30 false negative vessels in CTP, FFR range was 0.35-0.80. Receiver-operating-characteristics curve analysis demonstrated a significantly larger area under the curve for FFRCT (0.87) compared with that for CTP (0.67; P < 0.001) and CTA (0.77; P = 0.004). Conclusion(s): Based on this cohort of patients FFRCT is superior to CTP in detecting haemodynamically significant coronary stenosis.

Introduction: Computed-tomography (CT) derived fractional flow reserve (CT-FFR) and CT stress myocardial perfusion imaging (CTP) are emerging techniques to assess the haemodynamic significance of coronary stenoses. Computation of CT-FFR using analysis conditions derived from structural deformation of coronary lumen and aorta with reduced order modelling has been recently described to be feasible. Comparison of diagnostic performance with visually assessed CTP is not known. The aim of this study is to compare the diagnostic performance of CT-FFR and CTP in detecting fractional-flow-reserve (FFR) defined haemodynamically significant stenosis (FFR <=0.8). Method(s): Forty-four patients (79 vessels) with suspected coronary artery disease from a single institution planned for elective coronary angiography with invasive FFR prospectively underwent 320-detector CT coronary angiogram (CTA) and CTP. Analyses were performed in separate core laboratories for CT-FFR and CTP blinded to FFR results. For CT-FFR, deformation of coronary cross-sectional lumen and aorta, computed from diastolic CTA images, was used to determine analysis conditions. CT-FFR was derived using a reduced order model with dedicated software on a standard desktop computer. Myocardial perfusion was assessed visually by consensus of two interpreters. Result(s): Invasive FFR was significant in 26 (33%) vessels. Overall per-vessel sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for CT-FFR were 81%, 85%, 72%, 90%, 84% respectively and those of CTP were 50%, 91%, 76%, 76% and 76% respectively. Among the 13 false negative vessels in CTP, FFR range was 0.65-0.80 with a mean FFR and interquartile range of 0.76 and 0.75 to 0.80 respectively. Receiver operator characteristics curve analysis showed a significantly larger area under curve for CT-FFR (0.89) compared with that for CTP (0.71) and coronary CTA (0.77), p = 0.045. Conclusion(s): Based on this cohort of pa

Background: Computed tomography derived fractional flow reserve (CT-FFR) and computed tomography stress myocardial perfusion imaging (CTP) are emerging techniques to assess the haemodynamic significance of coronary stenoses. Computation of CT-FFR using analysis conditions derived from structural deformation of coronary lumen and aorta and reduced order modelling has been recently described to be feasible. Comparison of diagnostic performance with visually assessed CTP is not known. Purpose(s): To compare the diagnostic performance of CT-FFR and CTP in detecting haemodynamically significant stenosis (FFR <=0.8), using invasive FFR as a reference standard. Method(s): Forty-three patients (77 vessels) with suspected coronary artery disease from a single institution planned for elective coronary angiography with invasive FFR prospectively underwent 320-detector coronary CTA and CTP. Analyses were performed in separate core laboratories for CT-FFR and CTP blinded to FFR results. For CT-FFR, deformation of coronary cross-sectional lumen and aorta, computed from diastolic CTA images, was used to determine analysis conditions based on hierarchical Bayes modelling. CT-FFR was derived using a reduced order model with dedicated software on a standard desktop computer. Myocardial perfusion was assessed visually by consensus of two interpreters. Result(s): Invasive FFR was significant in 24 (31%) vessels. CT-FFR and CTP analyses were feasible in 100% and 88% of vessels respectively. Overall pervessel sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for CT-FFR were 79%, 85%, 70%, 90%, 83% respectively and those of CTP were 50%, 91%, 75%, 77% and 77% respectively. Among the 12 false negative vessels in CTP, FFR range was 0.65-0.80. ROC curve analysis showed a significantly larger AUC for CT-FFR (0.89) compared with that for CTP (0.71; p=0.02). Conclusion(s): Based on this cohort of patients CT-FFR is superior to CTP in detectin

Introduction: Computed-tomography (CT) derived fractional flow reserve (CT-FFR) and CT stress myocardial perfusion imaging (CTP) are emerging techniques to assess the haemodynamic significance of coronary stenoses. Computation of CT-FFR using analysis conditions derived from structural deformation of coronary lumen and aorta with reduced order modelling has been recently described to be feasible. Comparison of diagnostic performance with visually assessed CTP is not known. Objective(s): To compare the diagnostic performance of CT-FFR and CTP in detecting fractional-flow-reserve (FFR) defined haemodynamically significant stenosis (FFR <0.8). Method(s): Forty-four patients (79 vessels) with suspected coronary artery disease from a single institution planned for elective coronary angiography with invasive FFR, prospectively underwent 320-detector coronary CT angiogram and CTP. Analyses were performed in separate core laboratories for CT-FFR and CTP blinded to FFR results. For CT-FFR, deformation of coronary cross-sectional lumen and aorta, computed from diastolic CTA images, was used to determine analysis conditions. CT-FFR was derived using a reduced order model with dedicated software on a standard desktop computer. Myocardial perfusion was assessed visually by consensus of two interpreters. Result(s): Invasive FFR was significant in 26 (33%) vessels. Receiver operator characteristics curve analysis showed a significantly larger area under curve for CT-FFR (0.89) compared with CTP (0.71; p = 0.01). Per-vessel Sensitivity Specificity PPV NPV Accuracy [Table Presented] Conclusion(s): Based on this cohort of patients CT-FFR is superior to CTP in detecting haemodynamically significant coronary stenosis.