A 2-year investigation of the impact of the computed tomography-derived fractional flow reserve calculated using a deep learning algorithm on routine decision-making for coronary artery disease management

Eur Radiol. 2021 Sep;31(9):7039-7046. doi: 10.1007/s00330-021-07771-7. Epub 2021 Feb 25.


Objective: This study aims to investigate the safety and feasibility of using a deep learning algorithm to calculate computed tomography angiography-based fractional flow reserve (DL-FFRCT) as an alternative to invasive coronary angiography (ICA) in the selection of patients for coronary intervention.

Materials and methods: Patients (N = 296) with symptomatic coronary artery disease identified by coronary computed tomography angiography (CTA) with stenosis over 50% were retrospectively enrolled from a single centre in this study. ICA-guided interventions were performed in patients at admission, and DL-FFRCT was conducted retrospectively. The influences on decision-making by using DL-FFRCT and the clinical outcome were compared to those of ICA-guided care for symptomatic CAD at the 2-year follow-up evaluation.

Result: Two hundred forty-three patients were evaluated. Up to 72% of diagnostic ICA studies could have been avoided by using a DL-FFRCT value > 0.8 as a cut-off for intervention. A similar major adverse cardiovascular event (MACE) rate was observed in patients who underwent revascularisation with a DL-FFRCT value ≤ 0.8 (2.9%) compared to that of ICA-guided interventions (3.3%) (stented lesions with ICA stenosis > 75%) (p = 0.838).

Conclusion: DL-FFRCT can reduce the need for diagnostic coronary angiography when identifying patients suitable for coronary intervention. A low MACE rate was found in a 2-year follow-up investigation.

Key points: • Seventy-two percent of diagnostic ICA studies could have been avoided by using a DL-FFRCT value > 0.8 as a cut-off for intervention. • Coronary artery stenting based on the diagnosis by using a 320-detector row CT scanner and a positive DL-FFRCT value could potentially be associated with a lower occurrence rate of major adverse cardiovascular events (2.9%) within the first 2 years. • A low event rate was found when intervention was performed in tandem lesions with haemodynamic significance based on DL-FFRCT < 0.8 as a cut-off value.

Keywords: Computed tomography angiography; Coronary artery disease; Deep learning; Myocardial fractional flow reserve; Myocardial revascularisation.

MeSH terms

  • Algorithms
  • Computed Tomography Angiography
  • Coronary Angiography
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / therapy
  • Coronary Stenosis* / diagnostic imaging
  • Coronary Stenosis* / therapy
  • Deep Learning*
  • Fractional Flow Reserve, Myocardial*
  • Hemodynamics
  • Humans
  • Predictive Value of Tests
  • Retrospective Studies
  • Severity of Illness Index
  • Tomography, X-Ray Computed