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Influence of coronary stenosis location on diagnostic performance of machine learning-based fractional flow reserve from CT angiography
Med Univ South Carolina, SC 29425 USA; Justus Liebig Univ Giessen, Germany.
Med Univ South Carolina, SC 29425 USA; Univ Med Ctr Mannheim, Germany.
Justus Liebig Univ Giessen, Germany.
Med Univ South Carolina, SC 29425 USA; St Johannes Hosp, Germany.
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2021 (English)In: JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY, ISSN 1934-5925, Vol. 15, no 6, p. 492-498Article in journal (Refereed) Published
Abstract [en]

Background: Compared with invasive fractional flow reserve (FFR), coronary CT angiography (cCTA) is limited in detecting hemodynamically relevant lesions. cCTA-based FFR (CT-FFR) is an approach to overcome this insufficiency by use of computational fluid dynamics. Applying recent innovations in computer science, a machine learning (ML) method for CT-FFR derivation was introduced and showed improved diagnostic performance compared to cCTA alone. We sought to investigate the influence of stenosis location in the coronary artery system on the performance of ML-CT-FFR in a large, multicenter cohort. Methods: Three hundred and thirty patients (75.2% male, median age 63 years) with 502 coronary artery stenoses were included in this substudy of the MACHINE (Machine Learning Based CT Angiography Derived FFR: A MultiCenter Registry) registry. Correlation of ML-CT-FFR with the invasive reference standard FFR was assessed and pooled diagnostic performance of ML-CT-FFR and cCTA was determined separately for the following stenosis locations: RCA, LAD, LCX, proximal, middle, and distal vessel segments. Results: ML-CT-FFR correlated well with invasive FFR across the different stenosis locations. Per-lesion analysis revealed improved diagnostic accuracy of ML-CT-FFR compared with conventional cCTA for stenoses in the RCA (71.8% [95% confidence interval, 63.0%-79.5%] vs. 54.8% [45.7%-63.8%]), LAD (79.3 [73.9-84.0] vs. 59.6 [53.5-65.6]), LCX (84.1 [76.0-90.3] vs. 63.7 [54.1-72.6]), proximal (81.5 [74.6-87.1] vs. 63.8 [55.9-71.2]), middle (81.2 [75.7-85.9] vs. 59.4 [53.0-65.6]) and distal stenosis location (67.4 [57.0-76.6] vs. 51.6 [41.1-62.0]). Conclusion: In a multicenter cohort with high disease prevalence, ML-CT-FFR offered improved diagnostic performance over cCTA for detecting hemodynamically relevant stenoses regardless of their location.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC , 2021. Vol. 15, no 6, p. 492-498
Keywords [en]
Atherosclerosis; Coronary artery disease; Coronary computed tomography angiography; Fractional flow reserve; Machine learning
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:liu:diva-181198DOI: 10.1016/j.jcct.2021.05.005ISI: 000714977600009PubMedID: 34119471OAI: oai:DiVA.org:liu-181198DiVA, id: diva2:1613596
Available from: 2021-11-23 Created: 2021-11-23 Last updated: 2021-11-23

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de Geer, JakobPersson, Anders
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Division of Diagnostics and Specialist MedicineFaculty of Medicine and Health SciencesDepartment of Radiology in LinköpingCenter for Medical Image Science and Visualization (CMIV)
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