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Impact of coronary CT image quality on the accuracy of the FFRCT Planner

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To assess the accuracy of a virtual stenting tool based on coronary CT angiography (CCTA) and fractional flow reserve (FFR) derived from CCTA (FFRCT Planner) across different levels of image quality.

Materials and methods

Prospective, multicenter, single-arm study of patients with chronic coronary syndromes and lesions with FFR ≤ 0.80. All patients underwent CCTA performed with recent-generation scanners. CCTA image quality was adjudicated using the four-point Likert scale at a per-vessel level by an independent committee blinded to the FFRCT Planner. Patient- and technical-related factors that could affect the FFRCT Planner accuracy were evaluated. The FFRCT Planner was applied mirroring percutaneous coronary intervention (PCI) to determine the agreement with invasively measured post-PCI FFR.

Results

Overall, 120 patients (123 vessels) were included. Invasive post-PCI FFR was 0.88 ± 0.06 and Planner FFRCT was 0.86 ± 0.06 (mean difference 0.02 FFR units, the lower limit of agreement (LLA) − 0.12, upper limit of agreement (ULA) 0.15). CCTA image quality was assessed as excellent (Likert score 4) in 48.3%, good (Likert score 3) in 45%, and sufficient (Likert score 2) in 6.7% of patients. The FFRCT Planner was accurate across different levels of image quality with a mean difference between FFRCT Planner and invasive post-PCI FFR of 0.02 ± 0.07 in Likert score 4, 0.02 ± 0.07 in Likert score 3 and 0.03 ± 0.08 in Likert score 2, p = 0.695. Nitrate dose ≥ 0.8mg was the only independent factor associated with the accuracy of the FFRCT Planner (95%CI − 0.06 to − 0.001, p = 0.040).

Conclusion

The FFRCT Planner was accurate in predicting post-PCI FFR independent of CCTA image quality.

Clinical relevance statement

Being accurate in predicting post-PCI FFR across a wide spectrum of CT image quality, the FFRCT Planner could potentially enhance and guide the invasive treatment. Adequate vasodilation during CT acquisition is relevant to improve the accuracy of the FFRCT Planner.

Key Points

• The fractional flow reserve derived from coronary CT angiography (FFRCT) Planner is a novel tool able to accurately predict fractional flow reserve after percutaneous coronary intervention.

• The accuracy of the FFRCT Planner was confirmed across a wide spectrum of CT image quality. Nitrates dose at CT acquisition was the only independent predictor of its accuracy.

• The FFRCT Planner could potentially enhance and guide the invasive treatment.

Graphical abstract

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Abbreviations

BMI:

Body mass index

CCTA:

Coronary CT angiography

FFR:

Fractional flow reserve

FFRCT :

Fractional flow reserve derived from computed tomography

HR:

Heart rate

LAD:

Left anterior descending coronary artery

LLA:

Lower limit of agreement

LOA:

Limits of agreement

NTG:

Nitroglycerine

PCI:

Percutaneous coronary intervention

SNR:

Signal-to-noise ratio

ULA:

Upper limit of agreement

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Daniele Andreini and Marta Belmonte have equally contributed to this work.

Authors and Affiliations

  1. Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant’Ambrogio Hospital, IRCCS, Via Cristina Belgioioso 173, 20157, Milan, Italy

    Daniele Andreini

  2. Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy

    Daniele Andreini

  3. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium

    Marta Belmonte, Martin Penicka, Lieven Van Hoe, Niya Mileva, Pasquale Paolisso, Sakura Nagumo, Takuya Mizukami, Daniel Munhoz, Jeroen Sonck, Bernard De Bruyne & Carlos Collet

  4. Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy

    Marta Belmonte, Pasquale Paolisso & Daniel Munhoz

  5. Medical University of Sofia, Sofia, Bulgaria

    Niya Mileva

  6. Department of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan

    Sakura Nagumo & Takuya Mizukami

  7. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark

    Bjarne L. Nørgaard & Jesper Møller Jensen

  8. Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia

    Brian Ko

  9. Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

    Hiromasa Otake

  10. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea

    Bon-Kwon Koo

  11. HeartFlow Inc, Redwood City, USA

    Adam Updegrove & Charles Taylor

  12. Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada

    Jonathon Leipsic

  13. Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland

    Bernard De Bruyne

Authors
  1. Daniele Andreini
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  2. Marta Belmonte
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  4. Lieven Van Hoe
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  8. Bjarne L. Nørgaard
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  9. Brian Ko
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  13. Takuya Mizukami
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  15. Adam Updegrove
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  16. Charles Taylor
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  17. Jonathon Leipsic
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  18. Jeroen Sonck
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  19. Bernard De Bruyne
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  20. Carlos Collet
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Corresponding author

Correspondence to Daniele Andreini.

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Guarantor

The scientific guarantor of this publication is Prof. Daniele Andreini.

Conflict of interest

Bjarne Linde Norgaard and Jesper Moller Jensen have received unrestricted institutional research grants from HeartFlow Inc. Hiromasa Otake reports are receiving research grants from Abbott Vascular; and speaker fees for HeartFlow and Abbott Vascular. Bon-Kwon Koo reports institutional research grants provided by HeartFlow, Inc. Jonathon Leipsic is a consultant and holds stock options in Circle CVI and HeartFlow. He reports a research grant from GE and modest speaker fees for GE and Philips. Bernard De Bruyne reports receiving consultancy fees from Boston Scientific, and Abbott and receiving research grants from Coroventis Research, Pie Medical Imaging, CathWorks, Boston Scientific, Siemens, HeartFlow Inc., and Abbott Vascular. Carlos Collet reports receiving research grants from Biosensor, Coroventis Research, Medis Medical Imaging, Pie Medical Imaging, CathWorks, Boston Scientific, Siemens, HeartFlow Inc., and Abbott Vascular; and consultancy fees from Heart Flow Inc, Opsens, Abbott Vascular, and Philips Volcano. Daniele Andreini reports research grants from GE Healthcare and Bracco. Marta Belmonte, Pasquale Paolisso, and Daniel Munhoz report research grants provided by the Cardiopath Ph.D. program.

The other authors have nothing to disclose.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in the Precise Percutaneous Coronary Intervention Plan (P3) trial (NCT03782688). This is a sub-analysis of the P3 study.

Methodology

• prospective

• observational

• multicenter study

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Andreini, D., Belmonte, M., Penicka, M. et al. Impact of coronary CT image quality on the accuracy of the FFRCT Planner. Eur Radiol 34, 2677–2688 (2024). https://doi.org/10.1007/s00330-023-10228-8

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  • DOI: https://doi.org/10.1007/s00330-023-10228-8

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