PERFUSE Registry: Diagnostic Accuracy Achieved with CT-Derived FFR Plus CT Perfusion Imaging

PARIS, France—A strategy combining fractional flow reserve (FFR) derived from computed tomography (CT) with CT perfusion imaging has demonstrated high diagnostic accuracy in identifying inducible ischemia in patients with suspected coronary artery disease (CAD), according to a study presented Wednesday, May 21, 2014, at EuroPCR.

Young-Hak Kim, MD, PhD, of Asan Medical Center (Seoul, Korea), and colleagues analyzed 164 vessels from 57 patients with suspected CAD enrolled in the PERFUSE registry. FFR was performed in more than half (56%) of the vessels, and angiography showed stenosis of more than 90% in 31% of vessels and less than 20% in 13% of vessels.

Patients underwent coronary CT angiography, CT perfusion imaging, and invasive FFR, the latter serving as the reference standard for significant ischemia at a threshold of 0.80. Results were compared with noninvasive cFFR values, which were calculated using CT angiography datasets and the latest computational fluid dynamics software (Siemens, Forchheim, Germany). CT perfusion imaging was used in 46 patients for whom cFFR measurements were not available and thus were excluded from the main analysis.

Per-vessel sensitivity and specificity were comparable for cFFR, CT angiography, and combination imaging (table 1). Similar patterns were seen for per-patient values.

Table 1. Per-Vessel Diagnostic Accuracy



CT Angiography

cFFR + CT Perfusion Imaging









cFFR was proficient in diagnosing hemodynamically significant stenosis with an area under the curve of 0.913 (P < .001). Additionally cFFR showed comparable accuracy with invasive FFR.

The sensitivity and specificity of CT perfusion imaging in the 46 excluded patients were “very nice,” as well according to Dr. Kim. “In the clinical setting, CT perfusion and [cFFR] will run complementary,” he said.

cFFR appears to be accurate compared with invasive FFR or CT perfusion imaging, Dr. Kim concluded. “Analysis using both [cFFR] and [CT perfusion] may improve the diagnostic performance of CT-based functional imaging in detecting CAD,” he said.

Study Details

Patients who had available cFFR measurements tended to be younger, have higher BMIs, be more often diabetic, and be less likely to have multivessel disease than those without cFFR measurements.


Kim Y-H. PERFUSE registry for validation of computed tomography-derived coronary FFR and myocardial perfusion imaging. Presented at: EuroPCR; May 21, 2014; Paris, France.



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  • Dr. Kim reports no relevant conflicts of interest.