Thursday, October 27, 2011


I wrote in August on FFRCT, work by the Koreans and also the Latvians.
Well, the November issue of the Journal of the American College of Cardiology carried the print article of the Korean work, on the DISCOVER FLOW study. A multicenter study on the correlation between non-invasive FFR and coronary angiogram correlation. They studied 159 vessels in 103 patients. All these patients received FFRCT and also coronary angiogram. The study was headed by Dr Bon-Kwon Koo of Seoul National University Hospital, Seoul. Significant angiographic lesion was taken as 50% or greater, and significant flow limiting FFR was taken as <0.8.

Per vessel diagnostic accuracy FFRCT and CCTA (reference for both was invasive FFR)

Imaging technology
Accuracy (%)
Sensitivity (%)
Specificity (%)
Positive predictive value (%)
Negative predictive value (%)
a. Ischemic defined as <0.80
b. Ischemia defined as stenosis >50%

This table tells me 2 things. The normal 64slice CTA is not so good. Adding the FFRCT on to it, is so much better. I would have liked the investigators to have done FFR of the boderline lesions, during coronary arteriorgraphy, so that we can correlate and also make therapeutic decisions. If that decision is well correlated to FFRCT, then in future, we can do a FFRCT, analyse the data, and plan our PCI approach. I think that will save time and money and also better patientcare, instead of these adhoc PCIs that we now do,
I understand that that is the basis for the coming study the DEFACTO study, which results will be presented at the American Heart Association, annual scientific meeting in Orlando, next month.
I believe that this FFRCT is a game changer and will look forward to its clinical use. Now with the latest CT machines, the radiation dose is so small, that that has now become a non issue.
Alas, we await to see how much this FFRCT will cost, and I am told that it is very time soncuming. This will add to professional fees and cost.

No comments: