Computationally simulated fractional flow reserve from coronary computed tomography angiography based on fractional myocardial mass

Huan Han, Yong Gyun Bae, Seung Tae Hwang, Hyung Yoon Kim, Il Park, Sung Mok Kim, Yeonhyeon Choe, Young June Moon, Jin Ho Choi

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Computed tomography angiography (CCTA)-based calculations of fractional flow reserve (FFR) can improve the diagnostic performance of CCTA for physiologically significant stenosis but the computational resource requirements are high. This study aimed at establishing a simple and efficient algorithm for computing simulated FFR (S-FFR). A total of 107 patients who underwent CCTA and invasive FFR measurements were enrolled in the study. S-FFR was calculated using 145 evaluable coronary arteries with off-the-shelf softwares. FFR ≤ 0.80 was a reference threshold for diagnostic performance of diameter stenosis (DS) ≥ 50%, DS ≥ 70%, or S-FFR ≤ 0.80. FFR ≤ 0.80 was identified in 78 vessels (54%). In per-vessel analysis, S-FFR showed good correlation (r = 0.83) and agreement (mean difference = 0.02 ± 0.08) with FFR. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of S-FFR ≤ 0.80 for FFR ≤ 0.80 were 84%, 92%, 92%, 83%, and 88%, respectively. S-FFR ≤ 0.80 showed much higher predictive performance for FFR ≤ 0.80 compared with DS ≥ 50% or DS ≥ 70% (c-statistics = 0.92 vs. 0.58 or 0.65, p < 0.001, all). The classification agreement between FFR and S-FFR was > 80% when the average of FFR and S-FFR was < 0.76 or > 0.86. Per-patient analysis showed consistent results. In this study, a simple and computationally efficient simulated FFR (S-FFR) algorithm is designed and tested using non-proprietary off-the-shelf software. This algorithm may expand the accessibility of clinical applications for non-invasive coronary physiology study.

Original languageEnglish
Pages (from-to)185-193
Number of pages9
JournalInternational Journal of Cardiovascular Imaging
Issue number1
Publication statusPublished - 2019 Jan 15

Bibliographical note

Funding Information:
Funding This study was funded by This study was supported by Korean Society of Circulation Grant (201301-01), Korean Society of Interventional Cardiology Grant [2014-1], Samsung Biomedical Research Institute Grant [GL1B33211], Samsung Medical Center Heart Vascular and Stroke Institute Clinical Research Project (OTC1601861), and National Research Foundation of Korea (2017R1A2B3010918).

Publisher Copyright:
© 2018, Springer Nature B.V.


  • Computational coronary physiology
  • Computed tomography
  • Coronary circulation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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