Diagnostic performance of angiography-derived fractional flow reserve: A systematic review and Bayesian meta-analysis

Carlos Collet, Yoshinobu Onuma, Jeroen Sonck, Taku Asano, Bert Vandeloo, Ran Kornowski, Shengxian Tu, Jelmer Westra, Niels R. Holm, Bo Xu, Robbert J. De Winter, Jan G. Tijssen, Yosuke Miyazaki, Yuki Katagiri, Erhan Tenekecioglu, Rodrigo Modolo, Ply Chichareon, Bernard Cosyns, Daniel Schoors, Bram RoosensStijn Lochy, Jean Francois Argacha, Alexandre Van Rosendael, Jeroen Bax, Johan H.C. Reiber, Javier Escaned, Bernard De Bruyne, William Wijns, Patrick W. Serruys*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Aims Pressure-wire assessment of coronary stenosis is considered the invasive reference standard for detection of ischaemia-generating lesions. Recently, methods to estimate the fractional flow reserve (FFR) from conventional angiography without the use of a pressure wire have been developed, and were shown to have an excellent diagnostic accuracy. The present systematic review and meta-analysis aimed at determining the diagnostic performance of angiography-derived FFR for the diagnosis of haemodynamically significant coronary artery disease. Methods and results A systematic review and meta-analysis of studies assessing the diagnostic performance of angiography-derived FFR systems were performed. The primary outcome of interest was pooled sensitivity and specificity. Thirteen studies comprising 1842 vessels were included in the final analysis. A Bayesian bivariate meta-analysis yielded a pooled sensitivity of 89% (95% credible interval 83-94%), specificity of 90% (95% credible interval 88-92%), positive likelihood ratio (+LR) of 9.3 (95% credible interval 7.3-11.7) and negative likelihood ratio (-LR) of 0.13 (95% credible interval 0.07-0.2). The summary area under the receiver-operating curve was 0.84 (95% credible interval 0.66-0.94). Meta-regression analysis did not find differences between the methods for pressure-drop calculation (computational fluid dynamics vs. mathematical formula), type of analysis (on-line vs. off-line) or software packages. Conclusion The accuracy of angiography-derived FFR was good to detect haemodynamically significant lesions with pressure-wire measured FFR as a reference. Computational approaches and software packages did not influence the diagnostic accuracy of angiography-derived FFR. A diagnostic strategy trial with angiography-derived FFR evaluating clinical endpoints is warranted.

Original languageEnglish
Pages (from-to)3314-3321
Number of pages8
JournalEuropean Heart Journal
Issue number35
StatePublished - 14 Sep 2018


FundersFunder number
8Fu Wai Hospital
National Center for Cardiovascular Diseases
Saolta University Healthcare Group, Galway
Aarhus Universitetshospital
Academy of Medical Sciences
Imperial College London
National University of Ireland, Galway
Universiteit van Amsterdam
Universidad Complutense de Madrid
Erasmus Medisch Centrum
Academisch Medisch Centrum
Tel Aviv University
Shanghai Jiao Tong University
Leids Universitair Medisch Centrum


    • 3DQCA
    • Conventional angiography
    • Ischaemia
    • Significant lesion


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