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Background <p>CT-derived fractional flow reserve (CT-FFR) is a powerful tool for identifying hemodynamic ischemia. Coronary CT angiography (CCTA) images with the best quality in a cardiac cycle are conventionally reconstructed in clinical practice. To compare the diagnostic performance of machine learning (ML)-based CT-FFR between systolic and diastolic phases in identifying myocardial ischemia, using invasive fractional flow reserve (FFR) as a reference standard.</p> Methods <p>From December 2020 to October 2021, consecutive coronary artery disease (CAD) patients who underwent coronary computed tomography angiography (CCTA) and invasive FFR were prospectively enrolled. Prospective electrocardiographic (ECG)-triggered scan from 30% to 80% of R-R interval was applied on image extraction of all the patients. CT-FFR was implemented in systolic and diastolic phases for each target vessel.</p> Results <p>Ninety-six patients (mean age 62 ± 8, 31.3% female) with 98 vessels were successfully simulated in both systolic and diastolic phases. The area under the curve (AUC) was significantly higher in diastolic CT-FFR (0.885 vs. 0.790, <i>p</i> &lt; 0.001). The limits of agreement (LoA) range was narrower in diastolic CT-FFR (-0.134 to 0.148), compared with systolic CT-FFR (-0.234 to 0.273). Diastolic CT-FFR performed better than systolic CT-FFR in sensitivity (81.5% vs. 66.7%), specificity (83.1% vs. 71.8%), and accuracy (82.7% vs. 70.4%, all <i>p</i> &lt; 0.05). The LoA range was narrower for diastolic CT-FFR across all stenosis degree groups, with diagnostic performance better in sensitivity (84.0% vs. 68.0%) and accuracy (81.4% vs. 58.1%, <i>p</i> &lt; 0.001) among severe stenosis group.</p> Conclusions <p>In ML-based CT-FFR methods, diastolic CT-FFR showed better diagnostic performance and narrower LoA than systolic CT-FFR.</p> Trial Registration <p>The study has been registered through the Ethics Committee of Zhongshan Hospital, Fudan University, with the clinical trial number B2020-088R. The registration date is May 15, 2020.</p>

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Comparison of systolic and diastolic CT-FFR for myocardial ischemia diagnosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月26日

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  • Weifeng Guo,
  • Aizhu Sheng,
  • Yuan Wang,
  • Yige Lu,
  • Shihai Zhao,
  • Lekang Yin,
  • Yingjie Zhao,
  • Haijia Xu,
  • Hanbo Zhang,
  • Guanyu Qiao,
  • Li Shen,
  • Yang Pang,
  • Jiasheng Yin,
  • Zhifeng Yao,
  • Chenguang Li,
  • Shan Yang,
  • Cheng Yan,
  • Wei He,
  • Furong He,
  • Mengsu Zeng

摘要

Background

CT-derived fractional flow reserve (CT-FFR) is a powerful tool for identifying hemodynamic ischemia. Coronary CT angiography (CCTA) images with the best quality in a cardiac cycle are conventionally reconstructed in clinical practice. To compare the diagnostic performance of machine learning (ML)-based CT-FFR between systolic and diastolic phases in identifying myocardial ischemia, using invasive fractional flow reserve (FFR) as a reference standard.

Methods

From December 2020 to October 2021, consecutive coronary artery disease (CAD) patients who underwent coronary computed tomography angiography (CCTA) and invasive FFR were prospectively enrolled. Prospective electrocardiographic (ECG)-triggered scan from 30% to 80% of R-R interval was applied on image extraction of all the patients. CT-FFR was implemented in systolic and diastolic phases for each target vessel.

Results

Ninety-six patients (mean age 62 ± 8, 31.3% female) with 98 vessels were successfully simulated in both systolic and diastolic phases. The area under the curve (AUC) was significantly higher in diastolic CT-FFR (0.885 vs. 0.790, p < 0.001). The limits of agreement (LoA) range was narrower in diastolic CT-FFR (-0.134 to 0.148), compared with systolic CT-FFR (-0.234 to 0.273). Diastolic CT-FFR performed better than systolic CT-FFR in sensitivity (81.5% vs. 66.7%), specificity (83.1% vs. 71.8%), and accuracy (82.7% vs. 70.4%, all p < 0.05). The LoA range was narrower for diastolic CT-FFR across all stenosis degree groups, with diagnostic performance better in sensitivity (84.0% vs. 68.0%) and accuracy (81.4% vs. 58.1%, p < 0.001) among severe stenosis group.

Conclusions

In ML-based CT-FFR methods, diastolic CT-FFR showed better diagnostic performance and narrower LoA than systolic CT-FFR.

Trial Registration

The study has been registered through the Ethics Committee of Zhongshan Hospital, Fudan University, with the clinical trial number B2020-088R. The registration date is May 15, 2020.