A1 Journal article – refereed
Comparison of Coronary Computed Tomography Angiography, Fractional Flow Reserve, and Perfusion Imaging for Ischemia Diagnosis




List of Authors: Roel S. Driessen, Ibrahim Danad, Wijnand J. Stuijfzand, Pieter G. Raijmakers, Stefan P. Schumacher, Pepijn A. van Diemen, Jonathon A. Leipsic, Juhani Knuuti, Richard Underwood, Peter M. van de Ven, Albert C. van Rossum, Charles A. Taylor, Paul Knaapen
Publisher: ELSEVIER SCIENCE INC
Publication year: 2019
Journal: Journal of the American College of Cardiology
Journal name in source: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Journal acronym: J AM COLL CARDIOL
Volume number: 73
Issue number: 2
Number of pages: 13
ISSN: 0735-1097

Abstract

BACKGROUND

Fractional flow reserve (FFR) computation from coronary computed tomography angiography (CTA) datasets (FFRCT) has emerged as a promising noninvasive test to assess hemodynamic severity of coronary artery disease (CAD), but has not yet been compared with traditional functional imaging.

OBJECTIVES

The purpose of this study was to evaluate the diagnostic performance of FFRCT and compare it with coronary CTA, single-photon emission computed tomography (SPECT), and positron emission tomography (PET) for ischemia diagnosis.

METHODS

This subanalysis involved 208 prospectively included patients with suspected stable CAD, who underwent 256-slice coronary CTA, 99mTc-tetrofosmin SPECT, [15O] H2O PET, and routine 3-vessel invasive FFR measurements. FFRCT values were retrospectively derived from the coronary CTA images. Images from each modality were interpreted by core laboratories, and their diagnostic performances were compared using invasively measured FFR # 0.80 as the reference standard.

RESULTS

In total, 505 of 612 (83%) vessels could be evaluated with FFRCT. FFRCT showed a diagnostic accuracy, sensitivity, and specificity of 87%, 90%, and 86% on a per-vessel basis and 78%, 96%, and 63% on a per-patient basis, respectively. Area under the receiver-operating characteristic curve (AUC) for identification of ischemia-causing lesions was significantly greater for FFRCT (0.94 and 0.92) in comparison with coronary CTA (0.83 and 0.81; p < 0.01 for both) and SPECT (0.70 and 0.75; p < 0.01 for both), on a per-vessel and -patient level, respectively. FFRCT also outperformed PET on a per-vessel basis (AUC 0.87; p < 0.01), but not on a per-patient basis (AUC 0.91; p = 0.56). In the intention-todiagnose analysis, PET showed the highest per-patient and -vessel AUC followed by FFRCT (0.86 vs. 0.83; p = 0.157; and 0.90 vs. 0.79; p = 0.005, respectively).

CONCLUSIONS

In this study, FFRCT showed higher diagnostic performance than standard coronary CTA, SPECT, and PET for vessel-specific ischemia, provided coronary CTA images were evaluable by FFRCT, whereas PET had a favorable performance in per-patient and intention-to-diagnose analysis. Still, in patients in whom 3-vessel FFRCT could be analyzed, FFRCT holds clinical potential to provide anatomic and hemodynamic significance of coronary lesions. (J Am Coll Cardiol 2019; 73: 161-73) (c) 2019 by the American College of Cardiology Foundation.


Last updated on 2019-20-07 at 07:34