A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
The diagnostic performance of quantitative flow ratio and perfusion imaging in patients with prior coronary artery disease
Tekijät: van Diemen PA, de Winter RW, Schumacher SP, Everaars H, Bom MJ, Jukema RA, Somsen YB, Raijmakers PG, Kooistra RA, Timmer J, Maaniitty T, Robbers LF, von Bartheld MB, Demirkiran A, van Rossum AC, Reiber JH, Knuuti J, Underwood RS, Nagel E, Knaapen P, Driessen RS, Danad I
Kustantaja: OXFORD UNIV PRESS
Julkaisuvuosi: 2023
Journal: EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging
Tietokannassa oleva lehden nimi: EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING
Lehden akronyymi: EUR HEART J-CARD IMG
Sivujen määrä: 11
ISSN: 2047-2404
eISSN: 2047-2412
DOI: https://doi.org/10.1093/ehjci/jead197
Verkko-osoite: https://doi.org/10.1093/ehjci/jead197
Aims
In chronic coronary syndrome (CCS) patients with documented coronary artery disease (CAD), ischaemia detection by myocardial perfusion imaging (MPI) and an invasive approach are viable diagnostic strategies. We compared the diagnostic performance of quantitative flow ratio (QFR) with single-photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance imaging (CMR) in patients with prior CAD [previous percutaneous coronary intervention (PCI) and/or myocardial infarction (MI)].
Methods and results
This PACIFIC-2 sub-study evaluated 189 CCS patients with prior CAD for inclusion. Patients underwent SPECT, PET, and CMR followed by invasive coronary angiography with fractional flow reserve (FFR) measurements of all major coronary arteries (N = 567), except for vessels with a sub-total or chronic total occlusion. Quantitative flow ratio computation was attempted in 488 (86%) vessels with measured FFR available (FFR ≤0.80 defined haemodynamically significant CAD). Quantitative flow ratio analysis was successful in 334 (68%) vessels among 166 patients and demonstrated a higher accuracy (84%) and sensitivity (72%) compared with SPECT (66%, P < 0.001 and 46%, P = 0.001), PET (65%, P < 0.001 and 58%, P = 0.032), and CMR (72%, P < 0.001 and 33%, P < 0.001). The specificity of QFR (87%) was similar to that of CMR (83%, P = 0.123) but higher than that of SPECT (71%, P < 0.001) and PET (67%, P < 0.001). Lastly, QFR exhibited a higher area under the receiver operating characteristic curve (0.89) than SPECT (0.57, P < 0.001), PET (0.66, P < 0.001), and CMR (0.60, P < 0.001).
Conclusion
QFR correlated better with FFR in patients with prior CAD than MPI, as reflected in the higher diagnostic performance measures for detecting FFR-defined, vessel-specific, significant CAD.
