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Diagnostic accuracy of computed tomography-derived fractional flow reserve a systematic review

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Title: Diagnostic accuracy of computed tomography-derived fractional flow reserve a systematic review
Authors: Cook, CM
Petraco, R
Shun-Shin, MJ
Ahmad, Y
Nijjer, S
Al-Lamee, R
Kikuta, Y
Shiono, Y
Mayet, J
Francis, DP
Sen, S
Davies, JE
Item Type: Journal Article
Abstract: Importance Computed tomography–derived fractional flow reserve (FFR-CT) is a novel, noninvasive test for myocardial ischemia. Clinicians using FFR-CT must be able to interpret individual FFR-CT results to determine subsequent patient care. Objective To provide clinicians a means of interpreting individual FFR-CT results with respect to the range of invasive FFRs that this interpretation might likely represent. Evidence Review We performed a systematic review in accordance with guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A systematic search of MEDLINE (January 1, 2011, to 2016, week 2) and EMBASE (January 1, 2011, to 2016, week 2) was performed for studies assessing the diagnostic accuracy of FFR-CT. Title words used were computed tomography or computed tomographic and fractional flow reserve or FFR. Results were limited to publications in peer-reviewed journals. Duplicate studies and abstracts from scientific meetings were removed. All of the retrieved studies, including references, were reviewed. Findings There were 908 vessels from 536 patients in 5 studies included in the analysis. A total of 365 (68.1%) were male, and the mean (SD) age was 63.2 (9.5) years. The overall per-vessel diagnostic accuracy of FFR-CT was 81.9% (95% CI, 79.4%-84.4%). For vessels with FFR-CT values below 0.60, 0.60 to 0.70, 0.70 to 0.80, 0.80 to 0.90, and above 0.90, diagnostic accuracy of FFR-CT was 86.4% (95% CI, 78.0%-94.0%), 74.7% (95% CI, 71.9%-77.5%), 46.1% (95% CI, 42.9%-49.3%), 87.3% (95% CI, 85.1%-89.5%), and 97.9% (95% CI, 97.9%-98.8%), respectively. The 82% (overall) diagnostic accuracy threshold was met for FFR-CT values lower than 0.63 or above 0.83. More stringent 95% and 98% diagnostic accuracy thresholds were met for FFR-CT values lower than 0.53 or above 0.93 and lower than 0.47 or above 0.99, respectively. Conclusions and Relevance The diagnostic accuracy of FFR-CT varies markedly across the spectrum of disease. This analysis allows clinicians to interpret the diagnostic accuracy of individual FFR-CT results. In combination with patient-specific factors, clinicians can use FFR-CT to judge when the cost and risk of an invasive angiogram may safely be avoided.
Issue Date: 24-May-2017
Date of Acceptance: 14-Mar-2017
URI: http://hdl.handle.net/10044/1/51390
DOI: https://dx.doi.org/10.1001/jamacardio.2017.1314
ISSN: 2380-6591
Publisher: American Medical Association
Start Page: 803
End Page: 810
Journal / Book Title: JAMA Cardiology
Volume: 2
Issue: 7
Copyright Statement: © 2017 American Medical Association. All rights reserved.
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
CORONARY-ARTERY-DISEASE
CT ANGIOGRAPHY
BLOOD-FLOW
GUIDED PCI
PERFORMANCE
SEVERITY
STENOSIS
TRIAL
Publication Status: Published
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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