Fractional flow reserve derived from coronary CT angiography: variation of repeated analyses

J Cardiovasc Comput Tomogr. 2014 Jul-Aug;8(4):307-14. doi: 10.1016/j.jcct.2014.07.002. Epub 2014 Jul 11.


Background: Fractional flow reserve (FFR) is the standard of reference for assessing the hemodynamic significance of coronary stenoses in patients with stable coronary artery disease. Noninvasive FFR derived from coronary CT angiography (FFRCT) is a promising new noninvasive method for assessing the physiologic significance of epicardial stenoses. The reproducibility of FFRCT has not yet been established.

Objective: The aim of this study was to evaluate the variation of repeated analyses of FFRCT per se and in the context of the reproducibility of repeated FFR measurements.

Methods: Coronary CT angiography and invasive coronary angiography with repeated FFR measurements were performed in 28 patients (58 vessels) with suspected stable coronary artery disease. Based on the coronary CT angiography data set, FFRCT analyses were performed twice by 2 independent blinded analysts.

Results: In 12 of 58 (21%) vessels FFR was ≤ 0.80. The standard deviation for the difference between first and second FFRCT analyses was 0.034 vs 0.033 for FFR repeated measurements (P = .722). Limits of agreement were -0.06 to 0.08 for FFRCT and -0.07 to 0.06 for FFR. The coefficient of variation of FFRCT (CVFFRct) was 3.4% (95% confidence interval [CI], 1.4%-4.6%) vs 2.7% (95% CI, 1.8%-3.3%) for FFR. In vessels with mean FFR ranging between 0.70 and 0.90 (n = 25), the difference between the first and second FFRCT analyses was 0.035 and FFR repeated measurements was 0.043 (P = .357), whereas CVFFRct was 3.3% (95% CI, 1.5%-4.3%) and coefficient of variation for FFR was 3.6% (95% CI, 2.3%-4.6%).

Conclusions: The reproducibility of both repeated FFRCT analyses and repeated FFR measurements is high.

Keywords: Computational fluid dynamics; Computed tomography angiography; Coronary angiography; Fractional flow reserve; Invasive coronary angiography; Reproducibility.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Coronary Angiography / methods*
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / physiopathology
  • Coronary Vessels / diagnostic imaging*
  • Coronary Vessels / physiopathology
  • Female
  • Fractional Flow Reserve, Myocardial*
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Predictive Value of Tests
  • Prospective Studies
  • Reproducibility of Results
  • Tomography, X-Ray Computed*