The Accuracy of Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve and FFR Derived from Computed Tomography for Functional Assessment of Coronary Artery Disease

The Accuracy of Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve and FFR Derived from Computed Tomography for Functional Assessment of Coronary Artery Disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Accuracy of Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve and FFR Derived from Computed Tomography for Functional Assessment of Coronary Artery Disease Wenhao Huang, Jingyuan Zhang, Lin Yang, Yumeng Hu, Xiaochang Leng, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2656378/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Jun, 2023 Read the published version in BioMedical Engineering OnLine → Version 1 posted 9 You are reading this latest preprint version Abstract Background: Coronary computed tomography-derived fractional reserve fraction (CT-FFR) and intravascular ultrasound-derived fractional reserve fraction (IVUS-FFR) are methods of functional assessment based on coronary imaging; however, the calculation algorithms are substantially different between them. The aim of this study was to compare diagnostic performance between CT-FFR and IVUS-FFR using invasive fractional flow reserve (FFR) as the reference standard. Method: Our retrospective study enrolled 40 patients (41 lesions) with known or suspected coronary artery disease (CAD) between January 2020 and July 2021. Patients who completed coronary CT angiography (CCTA) within six months underwent intravascular ultrasound (IVUS) and fractional flow reserve (FFR) evaluation. We used a novel CFD-based model (AccuFFRct, ArteryFlow Technology Co., Ltd., Hangzhou, China) to compute the CT-FFR values, and a novel software (AccuFFRivus, ArteryFlow Technology Co., Ltd., Hangzhou, China) to calculate the IVUS-FFR values coupled with angiography. The diagnostic performance of CT-FFR and IVUS-FFR was evaluated using invasive FFR≤0.8 as the reference standard. Result: AccuFFRivus demonstrated a strong correlation with invasive FFR (R=0.7913, P<0.0001), and AccuFFRct was also highly associated with invasive FFR (R=0.6296, P<0.0001). Both AccuFFRivus and AccuFFRct showed good agreement with FFR. The area under the ROC curve was 0.960 (95%CI:0.833-0.997, P<0.001) for AccuFFRivus and 0.897 (95%CI:0.740-0.974, P<0.05) for AccuFFRct. A critical value of 0.80 for AccuFFRivus predicted FFR≤0.80 with high sensitivity (96.6%), specificity (85.7%), and the Youden index (0.823). AccuFFRct with predicted FFR≤0.80 demonstrated good diagnostic performance (sensitivity 89.7%, specificity 85.7% and Youden index 0.754). Conclusions: IVUS-FFR may also become a new clinically meaningful functional evaluation method for diagnosing myocardial ischemia and may be as important as CT-FFR, Angio-FFR, OCT-FFR, and invasive FFR in the future as a method for evaluating coronary artery disease. Coronary physiology Fractional Flow Reserve Intravascular Ultrasound Coronary Computed Tomography Angiography Diagnostic efficiency Full Text Additional Declarations Table 1 to 3 are available in the Supplementary Files section. Supplementary Files TABLE1BaselineClinicalPatientcharacteristic.docx TABLE2VesselandLesionCharacteristic.docx TABLE3DiagnosticPerformance.docx Cite Share Download PDF Status: Published Journal Publication published 27 Jun, 2023 Read the published version in BioMedical Engineering OnLine → Version 1 posted Editorial decision: Major revision 31 Mar, 2023 Reviews received at journal 30 Mar, 2023 Reviewers agreed at journal 27 Mar, 2023 Reviews received at journal 18 Mar, 2023 Reviewers agreed at journal 15 Mar, 2023 Reviewers invited by journal 14 Mar, 2023 Editor assigned by journal 06 Mar, 2023 Submission checks completed at journal 06 Mar, 2023 First submitted to journal 04 Mar, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2656378","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":181351600,"identity":"429f8ee7-b383-4989-a65f-dbfc3ea9afb1","order_by":0,"name":"Wenhao Huang","email":"","orcid":"","institution":"Zhejiang Chinese Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wenhao","middleName":"","lastName":"Huang","suffix":""},{"id":181351601,"identity":"13588781-fa20-440e-84e4-f4307e3f310f","order_by":1,"name":"Jingyuan Zhang","email":"","orcid":"","institution":"Zhejiang Chinese Medical 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for Functional Assessment of Coronary Artery Disease","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"biomedical-engineering-online","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmeo","sideBox":"Learn more about [BioMedical Engineering OnLine](http://biomedical-engineering-online.biomedcentral.com/)","snPcode":"12938","submissionUrl":"https://submission.nature.com/new-submission/12938/3","title":"BioMedical Engineering OnLine","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Coronary physiology, Fractional Flow Reserve, Intravascular Ultrasound, Coronary Computed Tomography Angiography , Diagnostic efficiency","lastPublishedDoi":"10.21203/rs.3.rs-2656378/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2656378/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Coronary computed tomography-derived fractional reserve fraction (CT-FFR) and intravascular ultrasound-derived fractional reserve fraction (IVUS-FFR) are methods of functional assessment based on coronary imaging; however, the calculation algorithms are substantially different between them. The aim of this study was to compare diagnostic performance between CT-FFR and IVUS-FFR using invasive fractional flow reserve (FFR) as the reference standard.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e Our retrospective study enrolled 40 patients (41 lesions) with known or suspected coronary artery disease (CAD) between January 2020 and July 2021. Patients who completed coronary CT angiography (CCTA) within six months underwent intravascular ultrasound (IVUS) and fractional flow reserve (FFR) evaluation. We used a novel CFD-based model (AccuFFRct, ArteryFlow Technology Co., Ltd., Hangzhou, China) to compute the CT-FFR values, and a novel software (AccuFFRivus, ArteryFlow Technology Co., Ltd., Hangzhou, China) to calculate the IVUS-FFR values coupled with angiography. The diagnostic performance of CT-FFR and IVUS-FFR was evaluated using invasive FFR≤0.8 as the reference standard.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e AccuFFRivus demonstrated a strong correlation with invasive FFR (R=0.7913, P\u0026lt;0.0001), and AccuFFRct was also highly associated with invasive FFR (R=0.6296, P\u0026lt;0.0001). Both AccuFFRivus and AccuFFRct showed good agreement with FFR. The area under the ROC curve was 0.960 (95%CI:0.833-0.997, P\u0026lt;0.001) \u0026nbsp;for AccuFFRivus and 0.897 (95%CI:0.740-0.974, P\u0026lt;0.05) for AccuFFRct. A critical value of 0.80 for AccuFFRivus predicted FFR≤0.80 with high sensitivity (96.6%), specificity (85.7%), and the Youden index (0.823). AccuFFRct with predicted FFR≤0.80 demonstrated good diagnostic performance (sensitivity 89.7%, specificity 85.7% and Youden index 0.754).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e IVUS-FFR may also become a new clinically meaningful functional evaluation method for diagnosing myocardial ischemia and may be as important as CT-FFR, Angio-FFR, OCT-FFR, and invasive FFR in the future as a method for evaluating coronary artery disease.\u003c/p\u003e","manuscriptTitle":"The Accuracy of Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve and FFR Derived from Computed Tomography for Functional Assessment of Coronary Artery Disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-09 15:09:00","doi":"10.21203/rs.3.rs-2656378/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-03-31T06:19:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-03-30T06:52:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52513eec-7f25-4d0b-8328-0ae9c64511e3","date":"2023-03-27T07:35:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-03-18T16:24:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26b0b5bc-aad3-4c73-875d-7e08c802ccf0","date":"2023-03-15T07:43:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-03-14T13:18:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-03-07T01:52:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-03-07T01:52:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BioMedical Engineering OnLine","date":"2023-03-05T04:47:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"biomedical-engineering-online","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmeo","sideBox":"Learn more about [BioMedical Engineering OnLine](http://biomedical-engineering-online.biomedcentral.com/)","snPcode":"12938","submissionUrl":"https://submission.nature.com/new-submission/12938/3","title":"BioMedical Engineering OnLine","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bc7a02d9-d2b7-49d3-bb8c-94141573700b","owner":[],"postedDate":"March 9th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T21:45:06+00:00","versionOfRecord":{"articleIdentity":"rs-2656378","link":"https://doi.org/10.1186/s12938-023-01122-x","journal":{"identity":"biomedical-engineering-online","isVorOnly":false,"title":"BioMedical Engineering OnLine"},"publishedOn":"2023-06-27 21:25:46","publishedOnDateReadable":"June 27th, 2023"},"versionCreatedAt":"2023-03-09 15:09:00","video":"","vorDoi":"10.1186/s12938-023-01122-x","vorDoiUrl":"https://doi.org/10.1186/s12938-023-01122-x","workflowStages":[]},"version":"v1","identity":"rs-2656378","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2656378","identity":"rs-2656378","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}