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Non-invasive instantaneous wave-free ratio using coronary CT angiography: diagnostic performance for evaluation of ischaemia-causing coronary stenosis confirmed by invasive fractional flow reserve



Non-invasive instantaneous wave-free ratio using coronary CT angiography: diagnostic performance for evaluation of ischaemia-causing coronary stenosis confirmed by invasive fractional flow reserve



Clinical Radiology 73(11): 983.E15-983.E22



To determine the diagnostic performance of instantaneous wave-free ratio (iFR) derived from non-invasive coronary computed tomography angiography (CTA; iFRCT) for ischaemia-causing coronary stenosis, and to compare the diagnostic efficacy of iFRCT, CTA, and CTA plus iFRCT. Thirty-nine patients (55 vessels) with known or suspected coronary artery disease were included. All patients underwent invasive coronary angiography and fractional flow reserve (FFR) according to CTA findings and clinical indicators. The same raw data used for CTA were used to build patient-specific computed flow dynamic models and to calculate iFRCT. On a vessel-based level, the correlation between iFRCT and FFR was moderate (r=0.65, p<0.05); the optimal iFRCT cut-off value was 0.85 based on an FFR cut-off value of 0.80, resulting in 85% sensitivity, 69% specificity, 61% positive predictive value (PPV), 89% negative predictive value (NPV), and 75% accuracy. The AUC showed significant differences between iFRCT and CTA (vessel-based: 0.84 versus 0.68; patient-based: 0.84 versus 0.62; both p<0.01). The accuracy of CTA combined with iFRCT was significantly increased compared to CTA alone for vessels with intermediate stenosis (83% versus 40%, p<0.01). iFRCT showed better diagnostic performance than CTA. iFRCT may be a promising method for detection of ischaemia-causing coronary stenosis, even in vessels with intermediate stenosis.

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Accession: 065357381

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PMID: 30093066

DOI: 10.1016/j.crad.2018.07.098


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