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 KoweekJonathon Leipsic

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Coronary artery fractional flow reserve (FFR) derived from CT angiography (FFTCT) enables functional assessment of coronary stenosis. Prior clinical trials showed 13%-33% of coronary CT angiography studies had insufficient quality for quantitative analysis with FFRCT. Purpose: To determine the rejection rate of FFRCT analysis and to determine factors associated with technically unsuccessful calculation of FFRCT. Materials and Methods: Prospectively acquired coronary CT angiography scans submitted as part of the Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care (ADVANCE) registry ( NCT02499679) and coronary CT angiography series submitted for clinical analysis were included. The primary outcome was the FFRCT rejection rate (defined as an inability to perform quantitative analysis with FFRCT). Factors that were associated with FFRCT rejection rate were assessed with multiple linear regression. Results: In the ADVANCE registry, FFRCT 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 FFRCT 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 FFRCT 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.

Original languageEnglish
Pages (from-to)597-605
Number of pages9
Issue number3
Publication statusPublished - 2019
Externally publishedYes


Dive into the research topics of 'Determinants of rejection rate for coronary CT angiography fractional flow reserve analysis'. Together they form a unique fingerprint.

Cite this