WHAT IS KNOWN? Software to compute angiography-derived FFR have been validated in clinical trials against PW-derived FFR with an AUC of 0.93 to 0.97. However,
New Research PaperCoronaryAnonymous Comparison of Various Angiography-Derived Fractional Flow Reserve Software With Pressure-Derived Physiological Assessment
Central Illustration
Section snippets
Patient selection
This study is a centralized off-line analysis by an independent academic core laboratory (CORRIB Corelab, University of Galway) of a prospective cohort of 444 vessels with both PW-iFR and PW-FFR measurements (NCT03857503).
The study population consisted of patients presenting with chronic coronary syndrome and having at least 1 epicardial coronary artery lesion with a 40% to 90% diameter stenosis by visual assessment on invasive coronary angiography. The angiographic exclusion criteria are
Study Population
The study enrolled 355 patients with 444 target vessels, 390 (87.8%) of which met the criteria for optimum quality (no table movement, optimal contrast filling, and separated angulation by 30° of the 2 angiographic views with minimal overlap/foreshortening), and their angiographies were provided to each analyst by the independent MI (Figure 1).
Patient and vessel characteristics are shown in Tables 1 and 2. The mean age of the patients was 68 ± 10 years, and 70% were men. The vessels included
Discussion
As illustrated in the Central Illustration, the main findings of our study are as follows:
- 1.
All 5 angio-FFR software/methods had good feasibility and comparable diagnostic accuracies.
- 2.
The diagnostic accuracy of angio-FFR software for predicting PW-FFR ≤0.80 was useful, with a higher discrimination compared with 2-dimensional QCA; however, it did not reach the diagnostic accuracy (AUC ≥0.9) reported in validation studies from the various vendors.6, 7, 8, 9
- 3.
Although angio-FFR is more reliable than
Conclusions
All 5 software/methods of angio-FFR tested in this blinded independent core lab analysis failed to achieve the previously reported high diagnostic performances achieved in validation trials when using PW-iFR/FFR as the reference standard. Therefore, further large studies are warranted to validate the intrinsic clinical value of angio-FFR.
Funding Support and Author Disclosures
Dr Serruys has received institutional grants from Sinomedical Sciences Technology, SMT (Sahajanand Medical Technologies), Philips/Volcano, Xeltis, and HeartFlow outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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Drs Ninomiya and Serruys contributed equally to this work.