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A meta-analysis comparing the diagnostic performance of computed tomography-derived fractional flow reserve and coronary computed tomography angiography at different levels of coronary artery calcium score

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Abstract

Objectives

The impact of coronary calcification on the diagnostic accuracy of computed tomography-derived fractional flow reserve (CT-FFR) and coronary computed tomography angiography (CCTA) remains a crucial consideration. This meta-analysis aims to compare the diagnostic performance of CT-FFR and CCTA at different levels of coronary artery calcium score (CACS).

Methods and results

We searched PubMed, Embase, and the Cochrane Library for relevant articles on CCTA, CT-FFR, and invasive fractional flow reserve (FFR). Ten studies were included to evaluate the diagnostic performance of CT-FFR and CCTA at the per-patient and per-vessel levels in four CACS groups. Invasive FFR was used as the reference standard. Except for the CACS ≥ 400 group, the AUC of CT-FFR was higher than those of CCTA in other subgroups of CACS (in CACS < 100 (per-patient, 0.9 (95% CI 0.87–0.92) vs. 0.32 (95% CI 0.28–0.36); per-vessel, 0.92 (95% CI 0.89–0.94) vs. 0.66 (95% CI 0.62–0.7); both p < 0.001), CACS ≥ 100 (per-patient, 0.86 (95% CI 0.82–0.88) vs. 0.44 (95% CI 0.4–0.48); per-vessel, 0.88 (95% CI 0.85–0.9) vs. 0.51 (95% CI 0.46–0.55); both p < 0.001), and CACS < 400 (per-patient, 0.9 (95% CI 0.87–0.93) vs. 0.74 (95% CI 0.7–0.78), p < 0.001; per-vessel, 0.8 (95% CI 0.76–0.83) vs. 0.74 (95% CI 0.7–0.78); p = 0.02)).

Conclusions

CT-FFR demonstrates superior diagnostic performance in low CACS groups (CACS < 400) than CCTA in detecting hemodynamic stenoses in patients with coronary artery disease (CAD).

Clinical relevance statement

Computed tomography-derived fractional flow reserve might be utilized to determine the necessity of invasive coronary angiography in coronary artery disease patients with coronary artery calcium score < 400.

Key Points

• There is a lack of meta-analysis comparing the diagnostic performance of computed tomography-derived fractional flow reserve and coronary computed tomography angiography at different levels of calcification.

• Computed tomography-derived fractional flow reserve only has a better diagnostic performance than coronary computed tomography angiography with low amounts of coronary calcium.

• For the low coronary artery calcium score group, computed tomography-derived fractional flow reserve might be a good non-invasive method to detect hemodynamic stenoses in coronary artery disease patients.

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Abbreviations

AUC:

Area under the curve

BMI:

Body mass index

CACS:

Coronary artery calcium score

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

CFD:

Computational fluid dynamics

CI:

Confidence intervals

CT-FFR:

Computed tomography-derived fractional flow reserve

DOR:

Diagnostic odds ratio

FN:

False negative

FP:

False positive

FFR:

Fractional flow reserve

HR:

Heart rate

ICA:

Invasive coronary angiography

ML:

Machine learning

NLR:

Negative likelihood ratio

PLR:

Positive likelihood ratio

SROC:

Summary receiver operating characteristic curve

TN:

True negatives

TP:

True positive

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Acknowledgements

The authors thank Ziyu An and Jingwen Yong, who helped for initial data analysis. During the revision process, we are very grateful that the biostatistician Zhechun Zhen provided guidance on the statistical section.

Funding

This study has received funding by the Beijing Nova Program (Z211100002121056).

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Authors and Affiliations

  1. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China

    Zhao Ma, Chenchen Tu, Baoen Zhang, Dongfeng Zhang, Xiantao Song & Hongjia Zhang

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  1. Zhao Ma
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  2. Chenchen Tu
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Correspondence to Dongfeng Zhang or Xiantao Song.

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Guarantor

The scientific guarantor of this publication is Xiantao Song.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Baoen Zhang and Chenchen Tu extracted the data independently and Hongjia Zhang resolved discrepancies to reach a consensus. Dongfeng Zhang and Zhechun Zhen kindly provided statistical advice for this manuscript.

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Zhao Ma and Chenchen Tu are first authors.

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Ma, Z., Tu, C., Zhang, B. et al. A meta-analysis comparing the diagnostic performance of computed tomography-derived fractional flow reserve and coronary computed tomography angiography at different levels of coronary artery calcium score. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10591-0

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  • DOI: https://doi.org/10.1007/s00330-024-10591-0

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