{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T16:59:56Z","timestamp":1782233996466,"version":"3.54.5"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T00:00:00Z","timestamp":1621987200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T00:00:00Z","timestamp":1621987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100012940","name":"Universit\u00e4tsklinikum T\u00fcbingen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012940","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>To evaluate computed tomography fractional flow reserve (FFR<jats:sub>CT<\/jats:sub>) values in distal parts of the coronaries in an asymptomatic cohort of marathon runners without any coronary stenosis for potentially false-positive values.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Ninety-eight asymptomatic male marathon runners (age 53 \u00b1 7 years) were enrolled in a prospective monocentric study and underwent coronary computed tomography angiography (CCTA). CCTA data were analyzed for visual coronary artery stenosis. FFR<jats:sub>CT<\/jats:sub> was evaluated in 59 participants without coronary artery stenosis in proximal, mid, and distal coronary sections using an on-site software prototype.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In participants without coronary artery stenosis, abnormal FFR<jats:sub>CT<\/jats:sub> values \u2264 0.8 in distal segments were found in 22 participants (37%); in 19 participants in the LAD; in 5 participants in the LCX; and in 4 participants in the RCA. Vessel diameters in participants with FFR<jats:sub>CT<\/jats:sub> values &gt; 0.80 compared to \u2264 0.80 were 1.6 \u00b1 0.3 mm versus 1.5 \u00b1 0.3 mm for distal LAD (<jats:italic>p = <\/jats:italic>0.025), 1.8 \u00b1 0.3 mm versus 1.6 \u00b1 0.5 mm for distal LCX (<jats:italic>p<\/jats:italic> = 0.183), and 2.0 \u00b1 0.4 mm versus 1.5 \u00b1 0.2 mm for distal RCA (<jats:italic>p<\/jats:italic> &lt; 0.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Abnormal FFR<jats:sub>CT<\/jats:sub> values of \u2264 0.8 frequently occurred in distal coronary segments in subjects without any anatomical coronary artery stenosis. This effect is only to some degree explainable by small distal vessel diameters. Therefore, the validity of hemodynamic relevance evaluation using FFR<jats:sub>CT<\/jats:sub> in distal coronary artery segment stenosis is reduced.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Points<\/jats:title>\n                <jats:p><jats:italic>\u2022 Abnormal FFR<\/jats:italic><jats:sub><jats:italic>CT<\/jats:italic><\/jats:sub><jats:italic> values (\u2264 0.8) occurred in over a third of the subjects in the distal LAD despite the absence of coronary artery stenosis..<\/jats:italic><\/jats:p>\n                <jats:p><jats:italic>\u2022 Therefore, the validity of hemodynamic relevance evaluation in distal coronary artery segment stenosis is reduced.<\/jats:italic><\/jats:p>\n                <jats:p><jats:italic>\u2022 Decision-making based on abnormal FFR<\/jats:italic><jats:sub><jats:italic>CT<\/jats:italic><\/jats:sub><jats:italic> values in distal vessel sections should be performed with caution and only in combination with visual assessment of the grade of stenosis..<\/jats:italic><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00330-021-08027-0","type":"journal-article","created":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T22:02:37Z","timestamp":1622066557000},"page":"8975-8982","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Prevalence of pathological FFRCT values without coronary artery stenosis in an asymptomatic marathon runner cohort"],"prefix":"10.1007","volume":"31","author":[{"given":"Sebastian","family":"Gassenmaier","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilias","family":"Tsiflikas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Greulich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Kuebler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Hagen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantin","family":"Nikolaou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas M.","family":"Niess","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christof","family":"Burgstahler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Krumm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,26]]},"reference":[{"key":"8027_CR1","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1056\/NEJMoa1205361","volume":"367","author":"B De Bruyne","year":"2012","unstructured":"De Bruyne B, Pijls NH, Kalesan B et al (2012) Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 367:991\u20131001","journal-title":"N Engl J Med"},{"key":"8027_CR2","doi-asserted-by":"publisher","first-page":"2105","DOI":"10.1016\/j.jacc.2007.01.087","volume":"49","author":"NH Pijls","year":"2007","unstructured":"Pijls NH, van Schaardenburgh P, Manoharan G et al (2007) Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol 49:2105\u20132111","journal-title":"J Am Coll Cardiol"},{"key":"8027_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/(SICI)1522-726X(200001)49:1<1::AID-CCD1>3.0.CO;2-5","volume":"49","author":"NH Pijls","year":"2000","unstructured":"Pijls NH, Kern MJ, Yock PG, De Bruyne B (2000) Practice and potential pitfalls of coronary pressure measurement. Catheter Cardiovasc Interv 49:1\u201316","journal-title":"Catheter Cardiovasc Interv"},{"key":"8027_CR4","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1056\/NEJMoa0807611","volume":"360","author":"PA Tonino","year":"2009","unstructured":"Tonino PA, De Bruyne B, Pijls NH et al (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360:213\u2013224","journal-title":"N Engl J Med"},{"key":"8027_CR5","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.jcct.2011.10.018","volume":"6","author":"A Salavati","year":"2012","unstructured":"Salavati A, Radmanesh F, Heidari K, Dwamena BA, Kelly AM, Cronin P (2012) Dual-source computed tomography angiography for diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. J Cardiovasc Comput Tomogr 6:78\u201390","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"8027_CR6","doi-asserted-by":"publisher","first-page":"2324","DOI":"10.1056\/NEJMoa0806576","volume":"359","author":"JM Miller","year":"2008","unstructured":"Miller JM, Rochitte CE, Dewey M et al (2008) Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 359:2324\u20132336","journal-title":"N Engl J Med"},{"key":"8027_CR7","doi-asserted-by":"publisher","first-page":"2135","DOI":"10.1016\/j.jacc.2008.08.058","volume":"52","author":"WB Meijboom","year":"2008","unstructured":"Meijboom WB, Meijs MF, Schuijf JD et al (2008) Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 52:2135\u20132144","journal-title":"J Am Coll Cardiol"},{"key":"8027_CR8","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.jcct.2007.04.008","volume":"1","author":"JH Cole","year":"2007","unstructured":"Cole JH, Chunn VM, Morrow JA, Buckley RS, Phillips GM (2007) Cost implications of initial computed tomography angiography as opposed to catheterization in patients with mildly abnormal or equivocal myocardial perfusion scans. J Cardiovasc Comput Tomogr 1:21\u201326","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"8027_CR9","doi-asserted-by":"publisher","first-page":"4341","DOI":"10.1007\/s00330-018-5856-6","volume":"29","author":"A Kosmala","year":"2019","unstructured":"Kosmala A, Petritsch B, Weng AM, Bley TA, Gassenmaier T (2019) Radiation dose of coronary CT angiography with a third-generation dual-source CT in a \u201creal-world\u201d patient population. Eur Radiol 29:4341\u20134348","journal-title":"Eur Radiol"},{"key":"8027_CR10","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1016\/j.jacc.2013.11.043","volume":"63","author":"BL Norgaard","year":"2014","unstructured":"Norgaard BL, Leipsic J, Gaur S et al (2014) Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol 63:1145\u20131155","journal-title":"J Am Coll Cardiol"},{"key":"8027_CR11","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1055\/s-0035-1551139","volume":"187","author":"I Tsiflikas","year":"2015","unstructured":"Tsiflikas I, Thomas C, Fallmann C et al (2015) Prevalence of subclinical coronary artery disease in middle-aged, male marathon runners detected by cardiac CT. Rofo 187:561\u2013568","journal-title":"Rofo"},{"key":"8027_CR12","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1111\/sms.13035","volume":"28","author":"C Burgstahler","year":"2018","unstructured":"Burgstahler C, Cipowicz H, Thomas C et al (2018) Coronary and carotid atherosclerosis in asymptomatic male marathon runners. Scand J Med Sci Sports 28:1397\u20131403","journal-title":"Scand J Med Sci Sports"},{"key":"8027_CR13","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.jcct.2018.10.026","volume":"13","author":"D Mastrodicasa","year":"2019","unstructured":"Mastrodicasa D, Albrecht MH, Schoepf UJ et al (2019) Artificial intelligence machine learning-based coronary CT fractional flow reserve (CT-FFRML): Impact of iterative and filtered back projection reconstruction techniques. J Cardiovasc Comput Tomogr 13:331\u2013335","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"8027_CR14","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1161\/01.CIR.51.4.5","volume":"51","author":"WG Austen","year":"1975","unstructured":"Austen WG, Edwards JE, Frye RL et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51:5\u201340","journal-title":"Circulation"},{"key":"8027_CR15","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1148\/rg.2020190164","volume":"40","author":"A Canan","year":"2020","unstructured":"Canan A, Ranganath P, Goerne H, Abbara S, Landeras L, Rajiah P (2020) CAD-RADS: Pushing the Limits. Radiographics 40:629\u2013652","journal-title":"Radiographics"},{"key":"8027_CR16","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1016\/j.jcct.2015.07.006","volume":"9","author":"I Roifman","year":"2015","unstructured":"Roifman I, Rezai MR, Wijeysundera HC, Chow BJ, Wright GA, Tu JV (2015) Utilization of cardiac computed tomography angiography and outpatient invasive coronary angiography in Ontario, Canada. J Cardiovasc Comput Tomogr 9:567\u2013571","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"8027_CR17","doi-asserted-by":"publisher","first-page":"3042","DOI":"10.1093\/eurheartj\/ehm466","volume":"28","author":"J Abdulla","year":"2007","unstructured":"Abdulla J, Abildstrom SZ, Gotzsche O, Christensen E, Kober L, Torp-Pedersen C (2007) 64-multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and meta-analysis. Eur Heart J 28:3042\u20133050","journal-title":"Eur Heart J"},{"key":"8027_CR18","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1016\/j.jcmg.2019.05.025","volume":"13","author":"KM Chinnaiyan","year":"2020","unstructured":"Chinnaiyan KM, Safian RD, Gallagher ML et al (2020) Clinical use of CT-derived fractional flow reserve in the emergency department. JACC Cardiovasc Imaging 13:452\u2013461","journal-title":"JACC Cardiovasc Imaging"},{"key":"8027_CR19","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1016\/j.amjcard.2014.07.064","volume":"114","author":"M Renker","year":"2014","unstructured":"Renker M, Schoepf UJ, Wang R et al (2014) Comparison of diagnostic value of a novel noninvasive coronary computed tomography angiography method versus standard coronary angiography for assessing fractional flow reserve. Am J Cardiol 114:1303\u20131308","journal-title":"Am J Cardiol"},{"key":"8027_CR20","doi-asserted-by":"publisher","first-page":"1989","DOI":"10.1016\/j.jacc.2011.06.066","volume":"58","author":"BK Koo","year":"2011","unstructured":"Koo BK, Erglis A, Doh JH et al (2011) Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol 58:1989\u20131997","journal-title":"J Am Coll Cardiol"},{"key":"8027_CR21","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1001\/2012.jama.11274","volume":"308","author":"JK Min","year":"2012","unstructured":"Min JK, Leipsic J, Pencina MJ et al (2012) Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA 308:1237\u20131245","journal-title":"JAMA"},{"key":"8027_CR22","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1161\/CIRCIMAGING.113.000297","volume":"6","author":"R Nakazato","year":"2013","unstructured":"Nakazato R, Park HB, Berman DS et al (2013) Noninvasive fractional flow reserve derived from computed tomography angiography for coronary lesions of intermediate stenosis severity: results from the DeFACTO study. Circ Cardiovasc Imaging 6:881\u2013889","journal-title":"Circ Cardiovasc Imaging"},{"key":"8027_CR23","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1007\/s00330-014-3482-5","volume":"25","author":"S Baumann","year":"2015","unstructured":"Baumann S, Wang R, Schoepf UJ et al (2015) Coronary CT angiography-derived fractional flow reserve correlated with invasive fractional flow reserve measurements--initial experience with a novel physician-driven algorithm. Eur Radiol 25:1201\u20131207","journal-title":"Eur Radiol"},{"key":"8027_CR24","doi-asserted-by":"publisher","first-page":"e007217","DOI":"10.1161\/CIRCIMAGING.117.007217","volume":"11","author":"A Coenen","year":"2018","unstructured":"Coenen A, Kim YH, Kruk M et al (2018) Diagnostic accuracy of a machine-learning approach to coronary computed tomographic angiography-based fractional flow reserve: result from the MACHINE consortium. Circ Cardiovasc Imaging 11:e007217","journal-title":"Circ Cardiovasc Imaging"},{"key":"8027_CR25","doi-asserted-by":"publisher","unstructured":"Nous FMA, Budde RPJ, Lubbers MM et al (2020) Impact of machine-learning CT-derived fractional flow reserve for the diagnosis and management of coronary artery disease in the randomized CRESCENT trials. Eur Radiol. https:\/\/doi.org\/10.1007\/s00330-020-06778-w","DOI":"10.1007\/s00330-020-06778-w"},{"key":"8027_CR26","doi-asserted-by":"publisher","unstructured":"Guo W, Lin Y, Taniguchi A et al (2021) Prospective comparison of integrated on-site CT-fractional flow reserve and static CT perfusion with coronary CT angiography for detection of flow-limiting coronary stenosis. Eur Radiol. https:\/\/doi.org\/10.1007\/s00330-020-07508-y","DOI":"10.1007\/s00330-020-07508-y"},{"key":"8027_CR27","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/j.jcct.2017.06.002","volume":"11","author":"MG Rabbat","year":"2017","unstructured":"Rabbat MG, Berman DS, Kern M et al (2017) Interpreting results of coronary computed tomography angiography-derived fractional flow reserve in clinical practice. J Cardiovasc Comput Tomogr 11:383\u2013388","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"8027_CR28","doi-asserted-by":"publisher","first-page":"2816","DOI":"10.1016\/j.jacc.2009.11.096","volume":"55","author":"PA Tonino","year":"2010","unstructured":"Tonino PA, Fearon WF, De Bruyne B et al (2010) Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol 55:2816\u20132821","journal-title":"J Am Coll Cardiol"},{"key":"8027_CR29","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1001\/jamacardio.2017.1314","volume":"2","author":"CM Cook","year":"2017","unstructured":"Cook CM, Petraco R, Shun-Shin MJ et al (2017) Diagnostic accuracy of computed tomography-derived fractional flow reserve : a systematic review. JAMA Cardiol 2:803\u2013810","journal-title":"JAMA Cardiol"},{"key":"8027_CR30","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1056\/NEJMoa1915922","volume":"382","author":"DJ Maron","year":"2020","unstructured":"Maron DJ, Hochman JS, Reynolds HR et al (2020) Initial invasive or conservative strategy for stable coronary disease. N Engl J Med 382:1395\u20131407","journal-title":"N Engl J Med"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-021-08027-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-021-08027-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-021-08027-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T12:13:29Z","timestamp":1636719209000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-021-08027-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,26]]},"references-count":30,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["8027"],"URL":"https:\/\/doi.org\/10.1007\/s00330-021-08027-0","relation":{},"ISSN":["0938-7994","1432-1084"],"issn-type":[{"value":"0938-7994","type":"print"},{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,26]]},"assertion":[{"value":"31 January 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2021","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2021","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 May 2021","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The scientific guarantor of this publication is Patrick Krumm.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors has significant statistical expertise.No complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Some study subjects or cohorts have been previously reported in:Tsiflikas I, Thomas C, Fallmann C et al (2015) Prevalence of subclinical coronary artery disease in middle-aged, male marathon runners detected by cardiac CT. Rofo 187:561\u2013568Burgstahler C, Cipowicz H, Thomas C et al (2018) Coronary and carotid atherosclerosis in asymptomatic male marathon runners. <i>Scand J Med Sci Sports<\/i> 28:1397\u20131403","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"value":"\u2022 Prospective\u2022 Diagnostic or prognostic study\u2022 performed at one institution","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}