Background: To evaluate the combined diagnostic accuracy of coronary computed tomography angiography (CCTA) and computed tomography derived fractional flow reserve (FFRct) in patients with suspected or known coronary artery disease (CAD).
Methods: PubMed, The Cochrane library, Embase and OpenGray were searched to identify studies comparing diagnostic accuracy of CCTA and FFRct. Diagnostic test measurements of FFRct were either extracted directly from the published papers or calculated from provided information. Bivariate models were conducted to synthesize the diagnostic performance of combined CCTA and FFRct at both "per-vessel" and "per-patient" levels.
Results: 7 articles were included for analysis. The combined diagnostic outcomes from "both positive" strategy, i.e. a subject was considered as "positive" only when both CCTA and FFRct were "positive", demonstrated relative high specificity (per-vessel: 0.91; per-patient: 0.81), high positive likelihood ratio (LR. +, per-vessel: 7.93; per-patient: 4.26), high negative likelihood ratio (LR. -, per-vessel: 0.30; per patient: 0.24) and high accuracy (per-vessel: 0.91; per-patient: 0.81) while "either positive" strategy, i.e. a subject was considered as "positive" when either CCTA or FFRct was "positive", demonstrated relative high sensitivity (per-vessel: 0.97; per-patient: 0.98), low LR. + (per-vessel: 1.50; per-patient: 1.17), low LR. - (per-vessel: 0.07; per-patient: 0.09) and low accuracy (per-vessel: 0.57; per-patient: 0.54).
Conclusion: "Both positive" strategy showed better diagnostic performance to rule in patients with non-significant stenosis compared to "either positive" strategy, as it efficiently reduces the proportion of testing false positive subjects.

Additional Metadata
Keywords Computed tomography derived fractional flow reserve, Coronary artery disease, Coronary artery stenosis, Coronary computed tomography angiography
Persistent URL dx.doi.org/10.1016/j.ijcard.2017.02.053, hdl.handle.net/1765/98340
Journal International Journal of Cardiology
Citation
Tan, X.W, Zheng, Q, Shi, L, Gao, F, Allen, J.C, Coenen, A, … Zhong, L. (2017). Combined diagnostic performance of coronary computed tomography angiography and computed tomography derived fractional flow reserve for the evaluation of myocardial ischemia: A meta-analysis. International Journal of Cardiology, 236, 100–106. doi:10.1016/j.ijcard.2017.02.053