Xiao Wei Tan1, Qishi Zheng2, Luming Shi3, Fei Gao4, John Carson Allen5, Adriaan Coenen6, Stefan Baumann7, U Joseph Schoepf8, Ghassan S Kassab9, Soo Teik Lim4, Aaron Sung Lung Wong4, Jack Wei Chieh Tan4, Khung Keong Yeo4, Chee Tang Chin4, Kay Woon Ho4, Swee Yaw Tan4, Terrance Siang Jin Chua4, Edwin Shih Yen Chan3, Ru San Tan4, Liang Zhong10. 1. National Heart Center Singapore, Singapore. 2. Singapore Clinical Research Institute, Singapore. 3. Singapore Clinical Research Institute, Singapore; Duke-NUS Medical School, Singapore. 4. National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore. 5. Duke-NUS Medical School, Singapore. 6. Department of Radiology and Cardiology, Erasmus University Medical Center, Rotterdam, Netherland. 7. First Department of Medicine-Cardiology, University Medical Centre Mannheim, affiliated at the DZHK (German Centre for Cardiovascular Research), Mannheim, Germany. 8. Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, United States. 9. California Medical Innovation Institute, San Diego, CA, United States. 10. National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore. Electronic address: zhong.liang@nhcs.com.sg.
Abstract
BACKGROUND: To evaluate the combined diagnostic accuracy of coronary computed tomography angiography (CCTA) and computed tomography derived fractional flow reserve (FFRct) in patients with suspected or known coronary artery disease (CAD). METHODS: PubMed, The Cochrane library, Embase and OpenGray were searched to identify studies comparing diagnostic accuracy of CCTA and FFRct. Diagnostic test measurements of FFRct were either extracted directly from the published papers or calculated from provided information. Bivariate models were conducted to synthesize the diagnostic performance of combined CCTA and FFRct at both "per-vessel" and "per-patient" levels. RESULTS: 7 articles were included for analysis. The combined diagnostic outcomes from "both positive" strategy, i.e. a subject was considered as "positive" only when both CCTA and FFRct were "positive", demonstrated relative high specificity (per-vessel: 0.91; per-patient: 0.81), high positive likelihood ratio (LR+, per-vessel: 7.93; per-patient: 4.26), high negative likelihood ratio (LR-, per-vessel: 0.30; per patient: 0.24) and high accuracy (per-vessel: 0.91; per-patient: 0.81) while "either positive" strategy, i.e. a subject was considered as "positive" when either CCTA or FFRct was "positive", demonstrated relative high sensitivity (per-vessel: 0.97; per-patient: 0.98), low LR+ (per-vessel: 1.50; per-patient: 1.17), low LR- (per-vessel: 0.07; per-patient: 0.09) and low accuracy (per-vessel: 0.57; per-patient: 0.54). CONCLUSION: "Both positive" strategy showed better diagnostic performance to rule in patients with non-significant stenosis compared to "either positive" strategy, as it efficiently reduces the proportion of testing false positive subjects.
BACKGROUND: To evaluate the combined diagnostic accuracy of coronary computed tomography angiography (CCTA) and computed tomography derived fractional flow reserve (FFRct) in patients with suspected or known coronary artery disease (CAD). METHODS: PubMed, The Cochrane library, Embase and OpenGray were searched to identify studies comparing diagnostic accuracy of CCTA and FFRct. Diagnostic test measurements of FFRct were either extracted directly from the published papers or calculated from provided information. Bivariate models were conducted to synthesize the diagnostic performance of combined CCTA and FFRct at both "per-vessel" and "per-patient" levels. RESULTS: 7 articles were included for analysis. The combined diagnostic outcomes from "both positive" strategy, i.e. a subject was considered as "positive" only when both CCTA and FFRct were "positive", demonstrated relative high specificity (per-vessel: 0.91; per-patient: 0.81), high positive likelihood ratio (LR+, per-vessel: 7.93; per-patient: 4.26), high negative likelihood ratio (LR-, per-vessel: 0.30; per patient: 0.24) and high accuracy (per-vessel: 0.91; per-patient: 0.81) while "either positive" strategy, i.e. a subject was considered as "positive" when either CCTA or FFRct was "positive", demonstrated relative high sensitivity (per-vessel: 0.97; per-patient: 0.98), low LR+ (per-vessel: 1.50; per-patient: 1.17), low LR- (per-vessel: 0.07; per-patient: 0.09) and low accuracy (per-vessel: 0.57; per-patient: 0.54). CONCLUSION: "Both positive" strategy showed better diagnostic performance to rule in patients with non-significant stenosis compared to "either positive" strategy, as it efficiently reduces the proportion of testing false positive subjects.
Authors: P J Blanco; C A Bulant; L O Müller; G D Maso Talou; C Guedes Bezerra; P A Lemos; R A Feijóo Journal: Sci Rep Date: 2018-11-22 Impact factor: 4.379