AccuFFRct (ArteryFlow Technology) is a novel noninvasive method for calculating fractional flow reserve (FFR) from coronary computed tomography angiography (CCTA). The accuracy of AccuFFRct has not been adequately assessed. This study sought to evaluate the diagnostic performance of AccuFFRct in detecting lesion-specific ischemia. This prospective study enrolled 339 patients with 404 vessels. CCTA-derived FFR was calculated using an on-site computational fluid dynamics–based method and compared with invasive FFR. The performance of AccuFFRct was comprehensively analyzed in all lesions and subgroups, including “gray zone” lesions, various lesion classifications, clinical presentations, stenosis severities, and lesion locations. Using FFR ≤0.80 as a reference standard, the overall diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for AccuFFRct were 90.6% (95% CI: 87.3%-93.3%), 90.9% (95% CI: 85.1%-94.9%), 90.4% (95% CI: 86.1%-93.8%), 85.3% (95% CI: 79.8%-89.5%), and 94.2% (95% CI: 90.8%-96.4%), respectively. Good correlation and agreement were found between the computed AccuFFRct and measured FFR. AccuFFRct showed superior discrimination ability to CCTA (AUC: 0.93 [95% CI: 0.89-0.95] vs 0.77 [95% CI: 0.72-0.81]; < 0.001) and quantitative coronary angiography (AUC: 0.93 [95% CI: 0.89-0.95] vs 0.89 [95% CI: 0.85-0.92]; 0.048) for identifying functionally significant stenosis. Notably, AccuFFRct maintained high diagnostic accuracy across the spectrum of lesion classifications, clinical presentations, stenosis severities, lesion locations, and in the “gray zone”. Furthermore, in the cohort with ≥70% stenosis, AccuFFRct could significantly reduce the rate of un-necessary invasive tests (33.1% vs 6.6%; < 0.001). The study confirms the potential of AccuFFRct as a noninvasive alternative to invasive FFR for detecting ischemia in coronary artery disease and to risk stratify patients. The results highlight AccuFFRct’s robust diagnostic ability across a wide range of lesion classifications, clinical presentations, stenosis severities, lesion locations, and in the “gray zone”. (Diagnostic Performance of Fractional Flow Reserve Derived From Coronary CT Angiography [ACCURATE-CT]; )

中文翻译：

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冠状动脉 CT 血管造影得出的血流储备分数的诊断性能：ACCURATE-CT 研究


AccuFFRct（ArteryFlow 技术）是一种新型无创方法，用于根据冠状动脉计算机断层扫描血管造影 (CCTA) 计算血流储备分数 (FFR)。 AccuFFRct 的准确性尚未得到充分评估。本研究旨在评估 AccuFFRct 在检测病变特异性缺血方面的诊断性能。这项前瞻性研究招募了 339 名患者，404 条血管。使用基于现场计算流体动力学的方法计算 CCTA 衍生的 FFR，并与侵入式 FFR 进行比较。 AccuFFRct 的性能在所有病变和亚组中进行了全面分析，包括“灰区”病变、各种病变分类、临床表现、狭窄严重程度和病变位置。以FFR≤0.80为参考标准，AccuFFRct的总体诊断准确性、敏感性、特异性、阳性预测值和阴性预测值分别为90.6%（95% CI：87.3%-93.3%）、90.9%（95% CI： 85.1%-94.9%)、90.4% (95% CI: 86.1%-93.8%)、85.3% (95% CI: 79.8%-89.5%) 和 94.2% (95% CI: 90.8%-96.4%)，分别。计算的 AccuFFRct 和测量的 FFR 之间存在良好的相关性和一致性。 AccuFFRct 显示出优于 CCTA（AUC：0.93 [95% CI：0.89-0.95] vs 0.77 [95% CI：0.72-0.81]；< 0.001）和定量冠状动脉造影（AUC：0.93 [95% CI：0.89）的辨别能力-0.95] vs 0.89 [95% CI: 0.85-0.92]；用于识别功能上显着的狭窄。值得注意的是，AccuFFRct 在病变分类、临床表现、狭窄严重程度、病变位置和“灰色地带”等方面都保持了较高的诊断准确性。此外，在狭窄≥70% 的队列中，AccuFFRct 可以显着降低不必要的侵入性测试的发生率（33.1% vs 6.6%；< 0.001）。 该研究证实了 AccuFFRct 作为侵入性 FFR 的无创替代方案的潜力，可用于检测冠状动脉疾病的缺血并对患者进行风险分层。结果突显了 AccuFFRct 在各种病变分类、临床表现、狭窄严重程度、病变位置和“灰色地带”方面的强大诊断能力。（冠状动脉 CT 血管造影得出的血流储备分数的诊断性能 [ACCURATE-CT]；）