TY - JOUR
T1 - Interoperator reliability of an on-site machine learning-based prototype to estimate CT angiography-derived fractional flow reserve
AU - Han, Yushui
AU - Ahmed, Ahmed Ibrahim
AU - Schwemmer, Chris
AU - Cocker, Myra
AU - Alnabelsi, Talal S.
AU - Saad, Jean Michel
AU - Giraldo, Juan C.Ramirez
AU - Al-Mallah, Mouaz H.
N1 - © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/3/21
Y1 - 2022/3/21
N2 - BACKGROUND: Advances in CT and machine learning have enabled on-site non-invasive assessment of fractional flow reserve (FFR
CT).
PURPOSE: To assess the interoperator and intraoperator variability of coronary CT angiography-derived FFR
CT using a machine learning-based postprocessing prototype.
MATERIALS AND METHODS: We included 60 symptomatic patients who underwent coronary CT angiography. FFR
CT was calculated by two independent operators after training using a machine learning-based on-site prototype. FFR
CT was measured 1 cm distal to the coronary plaque or in the middle of the segments if no coronary lesions were present. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to evaluate interoperator variability effect in FFR
CT estimates. Sensitivity analysis was done by cardiac risk factors, degree of stenosis and image quality.
RESULTS: A total of 535 coronary segments in 60 patients were assessed. The overall ICC was 0.986 per patient (95% CI 0.977 to 0.992) and 0.972 per segment (95% CI 0.967 to 0.977). The absolute mean difference in FFR
CT estimates was 0.012 per patient (95% CI for limits of agreement: -0.035 to 0.039) and 0.02 per segment (95% CI for limits of agreement: -0.077 to 0.080). Tight limits of agreement were seen on Bland-Altman analysis. Distal segments had greater variability compared with proximal/mid segments (absolute mean difference 0.011 vs 0.025, p<0.001). Results were similar on sensitivity analysis.
CONCLUSION: A high degree of interoperator and intraoperator reproducibility can be achieved by on-site machine learning-based FFR
CT assessment. Future research is required to evaluate the physiological relevance and prognostic value of FFR
CT.
AB - BACKGROUND: Advances in CT and machine learning have enabled on-site non-invasive assessment of fractional flow reserve (FFR
CT).
PURPOSE: To assess the interoperator and intraoperator variability of coronary CT angiography-derived FFR
CT using a machine learning-based postprocessing prototype.
MATERIALS AND METHODS: We included 60 symptomatic patients who underwent coronary CT angiography. FFR
CT was calculated by two independent operators after training using a machine learning-based on-site prototype. FFR
CT was measured 1 cm distal to the coronary plaque or in the middle of the segments if no coronary lesions were present. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to evaluate interoperator variability effect in FFR
CT estimates. Sensitivity analysis was done by cardiac risk factors, degree of stenosis and image quality.
RESULTS: A total of 535 coronary segments in 60 patients were assessed. The overall ICC was 0.986 per patient (95% CI 0.977 to 0.992) and 0.972 per segment (95% CI 0.967 to 0.977). The absolute mean difference in FFR
CT estimates was 0.012 per patient (95% CI for limits of agreement: -0.035 to 0.039) and 0.02 per segment (95% CI for limits of agreement: -0.077 to 0.080). Tight limits of agreement were seen on Bland-Altman analysis. Distal segments had greater variability compared with proximal/mid segments (absolute mean difference 0.011 vs 0.025, p<0.001). Results were similar on sensitivity analysis.
CONCLUSION: A high degree of interoperator and intraoperator reproducibility can be achieved by on-site machine learning-based FFR
CT assessment. Future research is required to evaluate the physiological relevance and prognostic value of FFR
CT.
KW - Biostatistics
KW - CORONARY ARTERY DISEASE
KW - Computed Tomography Angiography
KW - Severity of Illness Index
KW - Coronary Stenosis/diagnostic imaging
KW - Reproducibility of Results
KW - Fractional Flow Reserve, Myocardial/physiology
KW - Computed Tomography Angiography/methods
KW - Humans
KW - Coronary Angiography/methods
KW - Machine Learning
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U2 - 10.1136/openhrt-2021-001951
DO - 10.1136/openhrt-2021-001951
M3 - Article
C2 - 35314508
AN - SCOPUS:85127424652
SN - 2053-3624
VL - 9
JO - Open Heart
JF - Open Heart
IS - 1
M1 - e001951
ER -