Review Article

Computerised Methodologies for Non-Invasive Angiography-Derived Fractional Flow Reserve Assessment: A Critical Review

Table 1

Landmark studies investigating the accuracy of angiography-derived FFR software against invasive FFR.

StudyPatients (lesions)Diabetes mellitus (%)Previous myocardial infarctionLesion length (mm)Diameter stenosis (%)Prevalence of ischaemia (FFR≤0.80)Mean/median FFRCorrelationAUCExclusion criteria

VFR
Morris et al. [11]19 (19)55%NANANANA0.840.97Previous MI
Significant LMS stenosis
Previous CABG or PCI
Too obese for rotational coronary angiography
Morris et al. [13]20 (73)3045%NANANANA0.771Previous CABG
Chronic total occlusion
Acute presentation within the last 60 days
Gosling et al. [14]54 (59)2243%NANANA0.66 ± 0.140.870.93Previous CABG
Chronic total occlusion
Acute presentation within the last 60 days

vFAI
Papafaklis et al. [15]120 (139)2831%59.4 ± 21.061.4 ± 13.137%0.84 (IQR 0.75–0.90)0.780.92 (0.86–0.96)Significant LMS disease
Bifurcation lesions
Infarct-related vessels
Vessels with ostial stenosis
Previous CABG

QFR
Tu et al. [16]77 (68)2922%NA46.6 ± 7.330%0.82 ± 0.100.810.93 (0.86–0.99)Interrogated vessel with significant overlap or foreshortening (>90%)
Hyperaemic image quality insufficient for frame counting
Mean pressure in the guiding catheter or blood haematocrit are unavailable
Tu et al. [17]73 (84)2732%NA46.1 ± 8.932%0.84 ± 0.080.770.92 (0.85–0.97)Ostial LMS or RCA lesion
Prior CABG
Xu et al. [19]304 (328)2816%13.1 ± 6.446.5 ± 11.334%0.82 ± 0.120.860.96 (0.94–0.98)Ostial lesions <3 mm from aorta
Severe vessel overlap or tortuosity
Luminal reduction due to myocardial bridge
Poor angiographic image quality
Main vessels with stenotic side branches downstream of interrogated lesion
Westra et al. [24]172 (255)10NANA50 ± 1236%0.82 ± 0.110.700.86 (0.81–0.91)Ostial LMS or RCA stenosis
<2 projections of visible stenosis
No nitroglycerin administration
Pressure wire position not documented
Westra et al. [18]272 (317)29NA9.64 (IQR 7.53–13.76)45 ± 1033%0.83 ± 0.090.830.92 (0.89–0.96)Medina type 1,1,1 and 1,0,1 lesions
Aorto-ostial lesions
Poor angiographic quality
No nitroglycerin administration
Stenosis at or near large diameter shifts (>1 mm)
Severe tortuosity or overlap

FFRangio
Pellicano et al. [20]184 (203)3219%NANANA0.81 ± 0.110.810.93Ostial LMS or RCA stenosis
LMS stenosis
In-stent restenosis of the target vessel
Previous CABG
Diffuse coronary artery disease
Fearon et al. [25]301 (319)32NANA51 ± 1043%0.81 ± 0.130.800.94 (0.92–0.97)LMS stenosis >50%
Recent (<12 months) stent placement in the target vessel
In-stent restenosis
Severe diffuse disease
Target vessel supplied by collaterals
Inadequate angiographic image quality

FFRsim
Tar et al. [21]64 (68)2752%NA46NANA0.860.96 (0.91–1)Previous CABG
Bifurcation lesions
Ostial LMS stenosis

vFFR
Masdjedi et al. [22]100 (100)26NA20 ± 1337 ± 1342%0.82 ± 0.080.890.93 (0.88–0.97)LMS stenosis
Previous CABG with collaterals
Cardiogenic shock or severe haemodynamic instability
STEMI or lesions containing thrombus

AUC, area under the curve; CABG, coronary artery bypass grafting; FFR, fractional flow reserve; LMS, left main stem; MI, myocardial infarction; PCI, percutaneous coronary intervention; PCI, percutaneous coronary intervention; RCA, right coronary artery. Note. Tu (2014)—FFRQCA study.