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IntroductionThe idea to conduct a comprehensive analysis of our CT-FFR data was sparked by Castle Hill’s participation in the UK national audit from 2018 to 2021, during which our canter contributed 150 patient studies as one of the 12 participating sites. We aimed to study the adherence to the NICE guidelines for the use and referral for Heart-flow CT-FFR, assess the relationship between CT-FFR and coronary revascularisation as a clinical outcome as well as assessing the correlation and diagnostic accuracy of CT-FFR in comparison to invasive FFR.MethodsThe sample size was 654. CT-FFR studies sent from Castle Hill Hospital from 01/2019 to 10/2022 were randomly collected from the heart flow database and PACS workstations and patients’ characteristics were looked up in their health records. Angiography and any invasive physiological assessments done were reviewed as well.ResultsThe Nice guidelines for requesting CT-FFR were not followed in 54% of cases. 306 patients had significant CT-FFR. The revascularization occurred in 24% in patients with CT- FFR<0.8. CT FFR>0.8 was reported in 327 patients and only 1.5% were revascularized. CT-FFR is highly sensitive (94%) and has high NPV 98%) for revascularisation. CT-FFR has a modest specificity for predicting revascularization (58%) with PPV of only 23%. We tried to study the relation between CT-FFR results to invasive FFR results. The (PPV) of 53.86%, and the negative predictive value (NPV) was 100%. We do acknowledge the sample size of patients who had an invasive FFR test performed (n=35) and that can affect the precision of the diagnostic accuracy estimates and the external validity of our findings.ConclusionWe need to encourage reporters to adhere to the NICE guidelines in referral to the CT-FFR. The high sensitivity and the high NPV of CT-FFR make it a useful gatekeeper to ICA and can reliably predict that patients are very unlikely to receive. The reduced specificity and PPV of CT-FFR to predict revascularization is related to the many factors involved in the decision on revascularization. Adding to this is the clinical interpretation of CT-FFR and the matching cut-off values to the invasive FFR/iFR which are likely to improve in the future.

Coronary artery disease (CAD) is a major cause of ill health and death worldwide. Coronary computed tomographic angiography (CCTA) is the first-line investigation to detect CAD in symptomatic patients. This diagnostic approach risks greater second-line heart tests and treatments at a cost to the patient and health system. The National Health Service funded use of an artificial intelligence (AI) diagnostic tool, computed tomography (CT)-derived fractional flow reserve (FFR-CT), in patients with chest pain to improve physician decision-making and reduce downstream tests. This observational cohort study assessed the impact of FFR-CT on cardiovascular outcomes by including all patients investigated with CCTA during the national AI implementation program at 27 hospitals (CCTA n = 90,553 and FFR-CT n = 7,863). FFR-CT was safe, with no difference in all-cause ( n = 1,134 (3.2%) versus 1,612 (2.9%), adjusted-hazard ratio (aHR) 1.00 (0.93–1.08), P = 0.97) or cardiovascular mortality ( n = 465 (1.3%) versus 617 (1.1%), aHR 0.96 (0.85–1.08), P = 0.48), while reducing invasive coronary angiograms ( n = 5,720 (16%) versus 8,183 (14.9%), aHR 0.93 (0.90–0.97), P < 0.001) and noninvasive cardiac tests (189/1,000 patients versus 167/1,000), P < 0.001). Implementation of an AI-diagnostic tool as part of a health intervention program was safe and beneficial to the patient pathway and health system with fewer cardiac tests at 2 years. National implementation of a computed tomographic angiography and AI-diagnostic tool, CT-derived fractional flow reserve (FFR-CT), did not provide significant benefits in reducing mortality but led to fewer invasive coronary angiograms and downstream cardiac tests.

We describe a case of transient biventricular failure after pericardiocentesis in a patient with malignant thymoma. Within 1 week the cardiac function returned to normal. The epidemiology and pathophysiology of the post pericardiocentesis low cardiac output syndrome is discussed.

We describe a case of transient biventricular failure after pericardiocentesis in a patient with malignant thymoma. Within 1 week the cardiac function returned to normal. The epidemiology and pathophysiology of the post pericardiocentesis low cardiac output syndrome is discussed.