Diagnostic performance of angiography-derived fractional flow reserve: a systematic review and Bayesian meta-analysis. (20th August 2018)

• Record Type: Journal Article
• Authors: Collet, Carlos; Onuma, Yoshinobu; Sonck, Jeroen; Asano, Taku; Vandeloo, Bert; Kornowski, Ran; Tu, Shengxian; Westra, Jelmer; Holm, Niels R; Xu, Bo; de Winter, Robbert J; Tijssen, Jan G; Miyazaki, Yosuke; Katagiri, Yuki; Tenekecioglu, Erhan; Modolo, Rodrigo; Chichareon, Ply; Cosyns, Bernard; Schoors, Daniel; Roosens, Bram; Lochy, Stijn; Argacha, Jean-Francois; van Rosendael, Alexandre; Bax, Jeroen; Reiber, Johan H C; Escaned, Javier; De Bruyne, Bernard; Wijns, William; Serruys, Patrick W
• Is Part Of: European heart journal. Volume 39:Number 35(2018)
• Page Start: 3314
• Page End: 3321
• Publication Date: 2018-08-20
• Subjects: 3DQCA -- Conventional angiography -- Ischaemia -- Significant lesion; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehy445
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: Pressure-wire assessment of coronary stenosis is considered the invasive reference standard for detection of ischaemia-generating lesions. Recently, methods to estimate the fractional flow reserve (FFR) from conventional angiography without the use of a pressure wire have been developed, and were shown to have an excellent diagnostic accuracy. The present systematic review and meta-analysis aimed at determining the diagnostic performance of angiography-derived FFR for the diagnosis of haemodynamically significant coronary artery disease. Methods and results: A systematic review and meta-analysis of studies assessing the diagnostic performance of angiography-derived FFR systems were performed. The primary outcome of interest was pooled sensitivity and specificity. Thirteen studies comprising 1842 vessels were included in the final analysis. A Bayesian bivariate meta-analysis yielded a pooled sensitivity of 89% (95% credible interval 83–94%), specificity of 90% (95% credible interval 88–92%), positive likelihood ratio (+LR) of 9.3 (95% credible interval 7.3–11.7) and negative likelihood ratio (−LR) of 0.13 (95% credible interval 0.07–0.2). The summary area under the receiver-operating curve was 0.84 (95% credible interval 0.66–0.94). Meta-regression analysis did not find differences between the methods for pressure-drop calculation (computational fluid dynamics vs. mathematical formula), type of analysis (on-line vs. off-line) or software packages. Conclusion: The accuracy of angiography-derived FFR was good to detect haemodynamically significant lesions with pressure-wire measured FFR as a reference. Computational approaches and software packages did not influence the diagnostic accuracy of angiography-derived FFR. A diagnostic strategy trial with angiography-derived FFR evaluating clinical endpoints is warranted.