Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in coronary artery disease: A systematic review and meta-analysis

Abstract

Background: The study performed a meta-analysis of the diagnostic performance of fractional flow reserve (FFR) derived from coronary computed tomography angiography (FFRCT) to assess the functional significance of coronary stenosis using FFR as the reference standard.

Methods: We searched the electronic databases of PubMed, EMBASE, The Chorance Library, Medion and Web of Science for relevant articles published until August 2014. Pooled estimates of sensitivity, specificity, positive (LR+) and negative likelihood ratios (LR-) with the corresponding 95% confidence intervals (CIs) and the summary receiver operating characteristic curve (SROC) were determined.

Results: Five studies, 706 patients and 1165 vessels or lesions were included in the meta-analysis. The pooled sensitivity and specificity for FFRCT at the per-patient level were 90% (95% CI, 85%-93%) and 72% (95% CI, 67%-76%), respectively. The corresponding pooled LR+ and LR- were 3.70 (95% CI, 2.11-6.49) and 0.15 (95% CI, 0.11-0.22), respectively. The pooled sensitivity and specificity for FFRCT on the per-vessel or per-lesion basis were 83% (95% CI, 79%-87%) and 78% (95% CI, 75%-81%), respectively. Corresponding pooled LR+ and LR- were 3.75 (95% CI, 2.09-6.74) and 0.22 (95% CI, 0.18-0.29), respectively. The area under the SROC (AUC) was 0.94 at the per-patient level and 0. 91 at the per-vessel or per-lesion level.

Conclusions: The existing evidence suggests that noninvasive FFRCT has high diagnostic performance compared with invasively measured FFR for the detection of ischemia-causing stenosis in stable patients with suspected or known coronary artery disease (CAD).

Keywords: Coronary computed tomography angiography; Diagnostic accuracy; Fractional flow reserve; Meta-analysis.