Fractional flow reserve using computed tomography for assessing coronary artery disease: A meta-analysis

Aims: Noninvasive fractional flow reserve (FFR) measurement with computed tomography (FFR_CT) is a newly described method for assessing functional significance of coronary disease. The objective of this metaanalysis is to determine the diagnostic performance of FFR_CTin the assessment of hemodynamically significant coronary artery stenosis. Methods: PubMed and the Cochrane Center Register of Controlled Trials were searched from January 2000 through February 2015. Six original studies were found comparing FFR_CTto invasive FFR in evaluating hemodynamic significance of coronary lesions (1354 vessels; 812 patients). Lesions were considered hemodynamically significant if invasive FFR was 0.80 or less. FFR_CTused the same cutoff as invasive FFR to be considered as a positive test. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were calculated. Results: One-third of the lesions (n=443) were hemodynamically significant. The pooled per-vessel analysis showed that the sensitivity, specificity, negative and positive likelihood ratios, and diagnostic odds ratio of FFR_CTto diagnose hemodynamically significant coronary disease were 0.84 [95% confidence interval (CI):0.80-0.87], 0.76 (95% CI: 0.73-0.79), 0.22 (95% CI: 0.17-0.29), 3.48 (95% CI: 2.21-5.47), and 16.82 (95% CI: 8.20-34.49), respectively. Conclusion: The results of this meta-analysis demonstrate that FFR_CTresults correlate closely with invasive coronary angiography and FFR measurement. It is a feasible noninvasive method to assess hemodynamic significance of coronary lesions in patients with stable coronary artery disease.