Determinants of Rejection Rate for Coronary CT Angiography Fractional Flow Reserve Analysis

Gianluca Pontone; Jonathan R Weir-McCall; Andrea Baggiano; Alberico Del Torto; Laura Fusini; Marco Guglielmo; Giuseppe Muscogiuri; Andrea Igoren Guaricci; Daniele Andreini; Manesh Patel; Koen Nieman; Takashi Akasaka; Campbell Rogers; Bjarne L Nørgaard; Jeroen Bax; Gilbert L Raff; Kavitha Chinnaiyan; Daniel Berman; Timothy Fairbairn; Lynne Hurwitz Koweek; Jonathon Leipsic

doi:10.1148/radiol.2019182673

Determinants of Rejection Rate for Coronary CT Angiography Fractional Flow Reserve Analysis

Radiology. 2019 Sep;292(3):597-605. doi: 10.1148/radiol.2019182673. Epub 2019 Jul 23.

Authors

Gianluca Pontone¹, Jonathan R Weir-McCall¹, Andrea Baggiano¹, Alberico Del Torto¹, Laura Fusini¹, Marco Guglielmo¹, Giuseppe Muscogiuri¹, Andrea Igoren Guaricci¹, Daniele Andreini¹, Manesh Patel¹, Koen Nieman¹, Takashi Akasaka¹, Campbell Rogers¹, Bjarne L Nørgaard¹, Jeroen Bax¹, Gilbert L Raff¹, Kavitha Chinnaiyan¹, Daniel Berman¹, Timothy Fairbairn¹, Lynne Hurwitz Koweek¹, Jonathon Leipsic¹

Affiliation

¹ From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.).

PMID: 31335283
DOI: 10.1148/radiol.2019182673

Abstract

Background Coronary artery fractional flow reserve (FFR) derived from CT angiography (FFT_CT) enables functional assessment of coronary stenosis. Prior clinical trials showed 13%-33% of coronary CT angiography studies had insufficient quality for quantitative analysis with FFR_CT. Purpose To determine the rejection rate of FFR_CT analysis and to determine factors associated with technically unsuccessful calculation of FFR_CT. Materials and Methods Prospectively acquired coronary CT angiography scans submitted as part of the Assessing Diagnostic Value of Noninvasive FFR_CT in Coronary Care (ADVANCE) registry (https://ClinicalTrials.gov: NCT02499679) and coronary CT angiography series submitted for clinical analysis were included. The primary outcome was the FFR_CT rejection rate (defined as an inability to perform quantitative analysis with FFR_CT). Factors that were associated with FFR_CT rejection rate were assessed with multiple linear regression. Results In the ADVANCE registry, FFR_CT rejection rate due to inadequate image quality was 2.9% (80 of 2778 patients; 95% confidence interval [CI]: 2.1%, 3.2%). In the 10 621 consecutive patients who underwent clinical analysis, the FFR_CT rejection rate was 8.4% (n = 892; 95% CI: 6.2%, 7.2%; P < .001 vs the ADVANCE cohort). The main reason for the inability to perform FFR_CT analysis was the presence of motion artifacts (63 of 80 [78%] and 729 of 892 [64%] in the ADVANCE and clinical cohorts, respectively). At multivariable analysis, section thickness in the ADVANCE (odds ratio [OR], 1.04; 95% CI: 1.001, 1.09; P = .045) and clinical (OR, 1.03; 95% CI: 1.02, 1.04; P < .001) cohorts and heart rate in the ADVANCE (OR, 1.05; 95% CI: 1.02, 1.08; P < .001) and clinical (OR, 1.06; 95% CI: 1.05, 1.07; P < .001) cohorts were independent predictors of rejection. Conclusion The rates for technically unsuccessful CT-derived fractional flow reserve in the ADVANCE registry and in a large clinical cohort were 2.9% and 8.4%, respectively. Thinner CT section thickness and lower patient heart rate may increase rates of completion of CT fractional flow reserve analysis. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Sakuma in this issue.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cohort Studies
Computed Tomography Angiography / methods*
Coronary Angiography / methods*
Coronary Stenosis / diagnostic imaging*
Coronary Stenosis / physiopathology*
Female
Fractional Flow Reserve, Myocardial / physiology*
Humans
Male
Prospective Studies
Registries
Reproducibility of Results
Severity of Illness Index

Associated data

ClinicalTrials.gov/NCT02499679