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In Journal of clinical medicine

BACKGROUND : The aim is to compare the machine learning-based coronary-computed tomography fractional flow reserve (CT-FFRML) and coronary-computed tomographic morphological plaque characteristics with the resting full-cycle ratio (RFRTM) as a novel invasive resting pressure-wire index for detecting hemodynamically significant coronary artery stenosis.

METHODS : In our single center study, patients with coronary artery disease (CAD) who had a clinically indicated coronary computed tomography angiography (cCTA) and subsequent invasive coronary angiography (ICA) with pressure wire-measurement were included. On-site prototype CT-FFRML software and on-site CT-plaque software were used to calculate the hemodynamic relevance of coronary stenosis.

RESULTS : We enrolled 33 patients (70% male, mean age 68 ± 12 years). On a per-lesion basis, the area under the receiver operating characteristic curve (AUC) of CT-FFRML (0.90) was higher than the AUCs of the morphological plaque characteristics length/minimal luminal diameter4 (LL/MLD4; 0.80), minimal luminal diameter (MLD; 0.77), remodeling index (RI; 0.76), degree of luminal diameter stenosis (0.75), and minimal luminal area (MLA; 0.75).

CONCLUSION : CT-FFRML and morphological plaque characteristics show a significant correlation to detected hemodynamically significant coronary stenosis. Whole CT-FFRML had the best discriminatory power, using RFRTM as the reference standard.

Baumann Stefan, Hirt Markus, Rott Christina, Özdemir Gökce H, Tesche Christian, Becher Tobias, Weiss Christel, Hetjens Svetlana, Akin Ibrahim, Schoenberg Stefan O, Borggrefe Martin, Janssen Sonja, Overhoff Daniel, Lossnitzer Dirk


atherosclerosis, coronary CT angiography, coronary artery disease, coronary physiology, fractional flow reserve derived from coronary computed tomography angiography, invasive coronary angiography, myocardial infarction, resting full-cycle ratio, revascularization