VERMONT non-optimised: feasibility of angiography-derived vFFR using baseline diagnostic catheter images

Background: Vessel-fractional-flow-reserve (vFFR) estimates coronary physiology from the three-dimensional reconstruction of two angiographic projections using computational fluid dynamics. Although its diagnostic accuracy using optimised angiographic acquisitions is well established, evidence supporting its use with baseline diagnostic catheter images remains limited. Aims: To evaluate the diagnostic performance of real-time vFFR derived from baseline diagnostic catheter images against wire-based FFR, and to compare its performance with vFFR computed from optimised angiographic projections. Methods: VERMONT Non-Optimised was a prospective, single-centre, blinded study in which real-time vFFR derived from both baseline diagnostic and optimised images were measured and compared with simultaneous wire-based FFR. A wire-based FFR of ≤ 0.80 defined a physiologically significant lesion. Results: In 195 patients with 205 intermediate lesions, 56 (27.3%) lesions were excluded from vFFR analysis. vFFR derived from baseline diagnostic images demonstrated an AUC of 0.91 (95% CI,0.87–0.96) for detecting lesions with FFR ≤ 0.80, achieving 94% sensitivity, 75% specificity, a negative predictive value of 96%, and a positive predictive value of 67%. Baseline diagnostic and optimised vFFR were strongly correlated (R = 0.87,p < 0.001), with a mean bias of −0.0075 ± 0.0490 and an intraclass correlation coefficient of 0.93 (95% CI,0.90–0.95), indicating excellent agreement. Conclusion: Real-time vFFR derived from judiciously selected baseline diagnostic catheter images demonstrated strong overall accuracy and high sensitivity for detecting physiologically significant lesions, with similar diagnostic performance to vFFR derived from optimised images. These findings support the use of vFFR as a reliable screening tool for intermediate lesions in both prospective and retrospective settings.