Diagnostic performance of angiography-derived fractional flow reserve: a systematic review and Bayesian meta-analysis
Year: 2018
Type: review
Study designs: Systematic Review, Meta-Analysis
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.
Source: European Heart Journal
Authors: Carlos Collet, Yoshinobu Onuma, Jeroen Sonck, Taku Asano, Bert Vandeloo, Ran Kornowski, Shengxian Tu, Jelmer Westra, Niels R Holm, Bo Xu, Robbert J de Winter, Jan G Tijssen, Yosuke Miyazaki, Yuki Katagiri, Erhan Tenekecioglu, Rodrigo Modolo, Ply Chichareon, Bernard Cosyns, Daniel Schoors, Bram Roosens, Stijn Lochy, Jean-Francois Argacha, Alexandre van Rosendael, Jeroen Bax, Johan H C Reiber, Javier Escaned, Bernard De Bruyne, William Wijns, Patrick W Serruys
Institutions: Amsterdam UMC Location University of Amsterdam, Universitair Ziekenhuis Brussel, University of Amsterdam, Erasmus MC, Cardialysis (Netherlands), Tel Aviv University, Rabin Medical Center, Shanghai Jiao Tong University, Aarhus University Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Fu Wai Hospital, Leiden University Medical Center, Universidad Complutense de Madrid, Hospital Clínico San Carlos, Onze Lieve Vrouwziekenhuis Hospital, Ollscoil na Gaillimhe – University of Galway, Saolta University Health Care Group, Imperial College London
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2888716150