Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis.

Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 9602087 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-201X (Electronic) Linking ISSN: 13556037 NLM ISO Abbreviation: Heart Subsets: MEDLINE

Original Publication: London : BMJ Pub. Group, c1996-

Coronary Artery Disease*/diagnostic imaging ; Coronary Stenosis* ; Fractional Flow Reserve, Myocardial* ; Myocardial Infarction*; Computed Tomography Angiography/methods ; Coronary Angiography/methods ; Coronary Vessels/diagnostic imaging ; Humans ; Predictive Value of Tests ; Prognosis ; Tomography, X-Ray Computed

Objectives: To obtain more powerful assessment of the prognostic value of fractional flow reserve CT testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed clinical outcomes of CT-derived calculation of FFR (FFR CT ) (HeartFlow) analysis in patients with stable coronary artery disease (CAD).
Methods: We searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserve CT testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as 'all-cause mortality (ACM) or myocardial infarction (MI)' at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint.
Results: Five studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFR CT >0.80% and 1.4% (47/3334) with FFR CT ≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFR CT ≤0.80 versus patients with FFR CT >0.80. Each 0.10-unit FFR CT reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001).
Conclusions: The 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFR CT result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFR CT numerical value was inversely associated with outcomes.
Competing Interests: Competing interests: BLN has received unrestricted institutional research grants from Siemens and HeartFlow. TF has served on the Speakers Bureau for HeartFlow. PD has received research grants from HeartFlow. MRP has received research grants from HeartFlow, Bayer, Janssen, and the National Heart, Lung, and Blood Institute, and has served on the advisory board for HeartFlow, Bayer and Janssen. CR is employee of and owns equity in HeartFlow. SM is an employee of and owns equity in HeartFlow. KN has received institutional research support from Siemens Healthineers, HeartFlow, GE Healthcare and Bayer Healthcare. JL has served as a consultant for and owns stock options in Circle CVI and HeartFlow.
(© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Comment in: Heart. 2022 Feb;108(3):160-161. (PMID: 34782406)

Eur Heart J. 2018 Nov 1;39(41):3701-3711. (PMID: 30165613)
JACC Cardiovasc Imaging. 2017 May;10(5):541-550. (PMID: 27085447)
Eur Heart J. 2016 Apr 14;37(15):1220-7. (PMID: 26763790)
Radiology. 2019 Aug;292(2):343-351. (PMID: 31184558)
J Am Coll Cardiol. 2019 Jan 22;73(2):161-173. (PMID: 30654888)
J Am Coll Cardiol. 2016 Aug 2;68(5):435-445. (PMID: 27470449)
J Am Coll Cardiol. 2010 Jun 22;55(25):2816-21. (PMID: 20579537)
JACC Cardiovasc Imaging. 2020 Jan;13(1 Pt 1):97-105. (PMID: 31005540)
J Cardiovasc Comput Tomogr. 2018 Jan - Feb;12(1):e1. (PMID: 29191632)
JACC Cardiovasc Imaging. 2019 Jun;12(6):1032-1043. (PMID: 29550316)
J Am Coll Cardiol. 2014 Apr 1;63(12):1145-1155. (PMID: 24486266)
N Engl J Med. 2018 Sep 06;379(10):924-933. (PMID: 30145934)
J Am Coll Cardiol. 2018 Oct 30;72(18):2123-2134. (PMID: 30153968)
J Cardiovasc Comput Tomogr. 2017 Nov;11(6):462-467. (PMID: 28986147)
Circulation. 2018 Nov 13;138(20):e618-e651. (PMID: 30571511)
Eur Heart J Cardiovasc Imaging. 2018 Apr 1;19(4):405-414. (PMID: 28444153)
J Am Coll Cardiol. 2019 Oct 22;74(16):2058-2070. (PMID: 31623764)
J Am Coll Cardiol. 2013 Jun 4;61(22):2233-41. (PMID: 23562923)
Eur Heart J Cardiovasc Imaging. 2021 Sep 20;22(10):1182-1189. (PMID: 32793947)
Eur Heart J. 2014 Dec 14;35(47):3336-45. (PMID: 25416325)
Radiol Cardiothorac Imaging. 2019 Nov 21;1(5):e190050. (PMID: 33778528)
J Am Coll Cardiol. 2014 Oct 21;64(16):1641-54. (PMID: 25323250)
J Am Heart Assoc. 2017 Aug 22;6(8):. (PMID: 28862968)
JACC Cardiovasc Imaging. 2017 Jun;10(6):663-673. (PMID: 27771399)
Syst Rev. 2015 Jan 01;4:1. (PMID: 25554246)
JACC Cardiovasc Imaging. 2020 Oct;13(10):2264-2267. (PMID: 32682716)
Eur Heart J. 2020 Jan 14;41(3):407-477. (PMID: 31504439)
Radiol Cardiothorac Imaging. 2019 Jun 27;1(2):e190021. (PMID: 33778504)
Circ Cardiovasc Imaging. 2018 Jun;11(6):e007217. (PMID: 29914866)
Circulation. 2018 Jun 12;137(24):2635-2650. (PMID: 29891620)
N Engl J Med. 2015 Apr 2;372(14):1291-300. (PMID: 25773919)
Circulation. 2017 Jun 13;135(24):2320-2332. (PMID: 28389572)

Keywords: angina pectoris; computed tomography angiography; diagnostic imaging

Date Created: 20211023 Date Completed: 20220429 Latest Revision: 20220429

20231215

PMC8762006

10.1136/heartjnl-2021-319773

34686567