Comparison of Diagnostic Performance of Fractional Flow Reserve Derived from Coronary Computed Tomographic Angiography Versus Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging

Fraction flow reserve (FFR) derived from computed tomography (FFR) has been proposed to be an effective gatekeeper for invasive angiographic referral. The purpose of the present study is to examine the real-world diagnostic performance of FFR and myocardial perfusion imaging as well as to assess the utility of FFR as a gatekeeper for invasive coronary angiography in patients suspected of having obstructive coronary artery disease. Total of 146 consecutive patients underwent both single-photon emission computed tomography (SPECT) and invasive FFR were evaluated. An FFR value 1 to 2 cm distal to a stenosis ≤0.80 was defined as positive for ischemia and a summed stress score ≥2 or transient ischemic dilatation ≥1.2 were positive for ischemia with the invasive FFR value of <0.80 serving as the gold standard. The patient-based sensitivity of FFR was significantly higher than SPECT (91 vs 52%, p <0.001) and exhibited similar positive predictive value (82 vs 82%, p = 0.91). These trends were observed even in patients with multivessel and left main trunk disease and those with severe coronary calcification. In conclusion, our data suggest that FFR has higher diagnostic performance characteristics than SPECT and details the superior FFR analysis in detecting patients with hemodynamically significant coronary artery disease. Our results support the clinical utility of FFR analysis as a gatekeeper for invasive coronary angiography in clinical practice.