TY - JOUR
T1 - Determinants of rejection rate for coronary CT angiography fractional flow reserve analysis
AU - Pontone, Gianluca
AU - Weir-McCall, Jonathan R.
AU - Baggiano, Andrea
AU - Del Torto, Alberico
AU - Fusini, Laura
AU - Guglielmo, Marco
AU - Muscogiuri, Giuseppe
AU - Guaricci, Andrea Igoren
AU - Andreini, Daniele
AU - Patel, Manesh
AU - Nieman, Koen
AU - Akasaka, Takashi
AU - Rogers, Campbell
AU - Nørgaard, Bjarne L.
AU - Bax, Jeroen
AU - Raff, Gilbert L.
AU - Chinnaiyan, Kavitha
AU - Berman, Daniel
AU - Fairbairn, Timothy
AU - Koweek, Lynne Hurwitz
AU - Leipsic, Jonathon
N1 - Publisher Copyright:
© 2019 Radiological Society of North America Inc.. All rights reserved.
PY - 2019
Y1 - 2019
N2 - 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 (https://ClinicalTrials.gov: 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.
AB - 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 (https://ClinicalTrials.gov: 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.
UR - http://www.scopus.com/inward/record.url?scp=85071387239&partnerID=8YFLogxK
U2 - 10.1148/radiol.2019182673
DO - 10.1148/radiol.2019182673
M3 - Article
C2 - 31335283
AN - SCOPUS:85071387239
SN - 0033-8419
VL - 292
SP - 597
EP - 605
JO - Radiology
JF - Radiology
IS - 3
ER -