Diagnostic Accuracy of Computed Tomography-Derived Fractional Flow Reserve A Systematic Review

作者：Cook Christopher M; Petraco Ricardo; Shun Shin Matthew J; Ahmad Yousif; Nijjer Sukhjinder; Al Lamee Rasha; Kikuta Yuetsu; Shiono Yasutsugu; Mayet Jamil; Francis Darrel P; Sen Sayan; Davies Justin E^*

来源：JAMA Cardiology, 2017, 2(7): 803-810.

DOI：10.1001/jamacardio.2017.1314

IMPORTANCE Computed tomography-derived fractional flow reserve (FFR-CT) is a novel, noninvasive test for myocardial ischemia. Clinicians using FFR-CT must be able to interpret individual FFR-CT results to determine subsequent patient care.
OBJECTIVE To provide clinicians a means of interpreting individual FFR-CT results with respect to the range of invasive FFRs that this interpretation might likely represent.
EVIDENCE REVIEW We performed a systematic review in accordance with guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A systematic search of
MEDLINE (January 1, 2011, to 2016, week 2) and EMBASE (January 1, 2011, to 2016, week 2) was performed for studies assessing the diagnostic accuracy of FFR-CT. Title words used were computed tomography or computed tomographic and fractional flow reserve or FFR. Results were limited to publications in peer-reviewed journals. Duplicate studies and abstracts from scientific meetings were removed. All of the retrieved studies, including references, were reviewed.
FINDINGS There were 908 vessels from 536 patients in 5 studies included in the analysis. A total of 365 (68.1%) were male, and the mean (SD) age was 63.2 (9.5) years. The overall per-vessel diagnostic accuracy of FFR-CT was 81.9% (95% CI, 79.4%-84.4%). For vessels with FFR-CT values below 0.60, 0.60 to 0.70, 0.70 to 0.80, 0.80 to 0.90, and above 0.90, diagnostic accuracy of FFR-CT was 86.4%(95% CI, 78.0%-94.0%), 74.7%(95% CI, 71.9%-77.5%), 46.1%(95% CI, 42.9%-49.3%), 87.3%(95% CI, 85.1%-89.5%), and 97.9% (95% CI, 97.9%-98.8%), respectively. The 82%(overall) diagnostic accuracy threshold was met for FFR-CT values lower than 0.63 or above 0.83. More stringent 95% and 98% diagnostic accuracy thresholds were met for FFR-CT values lower than 0.53 or above 0.93 and lower than 0.47 or above 0.99, respectively.
CONCLUSIONS AND RELEVANCE The diagnostic accuracy of FFR-CT varies markedly across the spectrum of disease. This analysis allows clinicians to interpret the diagnostic accuracy of individual FFR-CT results. In combination with patient-specific factors, clinicians can use FFR-CT to judge when the cost and risk of an invasive angiogram may safely be avoided.

• 出版日期2017-7