Łukasz Wardziak1, Mariusz Kruk2, Weronika Pleban3, Marcin Demkow4, Witold Rużyłło5, Zofia Dzielińska6, Cezary Kępka7. 1. Coronary Artery Disease and Structural Heart Disease Department, Institute of Cardiology, Alpejska 42 St, 04-628, Warsaw, Poland. Electronic address: lukas.wardziak@gmail.com. 2. Coronary Artery Disease and Structural Heart Disease Department, Institute of Cardiology, Alpejska 42 St, 04-628, Warsaw, Poland; Laboratory of Noninvasive Diagnostics of Coronary Artery Disease, Institute of Cardiology, Alpejska 42 St, 04-628, Warsaw, Poland. Electronic address: mkruk@ikard.pl. 3. Coronary Artery Disease and Structural Heart Disease Department, Institute of Cardiology, Alpejska 42 St, 04-628, Warsaw, Poland. Electronic address: weronikapleban@gmail.com. 4. Coronary Artery Disease and Structural Heart Disease Department, Institute of Cardiology, Alpejska 42 St, 04-628, Warsaw, Poland. Electronic address: mdemkow@ikard.pl. 5. Coronary Artery Disease and Structural Heart Disease Department, Institute of Cardiology, Alpejska 42 St, 04-628, Warsaw, Poland. Electronic address: wruzyllo@ikard.pl. 6. Coronary Artery Disease and Structural Heart Disease Department, Institute of Cardiology, Alpejska 42 St, 04-628, Warsaw, Poland. Electronic address: zdzielinska@ikard.pl. 7. Coronary Artery Disease and Structural Heart Disease Department, Institute of Cardiology, Alpejska 42 St, 04-628, Warsaw, Poland; Laboratory of Noninvasive Diagnostics of Coronary Artery Disease, Institute of Cardiology, Alpejska 42 St, 04-628, Warsaw, Poland. Electronic address: ckepka@ikard.pl.
Abstract
BACKGROUND: CTA based FFR, a software based application, enhances diagnostic value of coronary computed tomography angiography (CTA) examination. However it remains unknown whether it improves accuracy over the gold standard of invasive coronary angiography (ICA) in predicting functionally significant coronary stenosis. The aim of our study was to compare diagnostic accuracies of coronary CTA, CTA based FFR, and ICA, with invasive FFR as the reference standard in patients with intermediate stenosis on CTA. METHODS: 96 intermediate stenoses (50-90%) from 90 subjects, with intermediate pre-test probability of CAD, who underwent coronary CTA were analyzed. Each patient had subsequent ICA with FFR. CTA based FFR (cFFR v2.1, Siemens) analysis was performed on-site. The stenoses with invasive FFR≤0.8 were considered hemodynamically significant. RESULTS: 41/96 stenoses were hemodynamically significant (FFR≤0.8). While the area under ROC curves (AUC) for identification of significant stenosis evaluated on QCA (0.653), visual ICA (0.652), qCTA (0.690) and visual CTA (0.660) did not significantly differ, the AUC for CTA based FFR (0.835) was significantly higher (p = 0.004, p = 0.004, p = 0.010, p = 0.007, respectively). The accuracies of CTA based FFR, qCTA and QCA were 76%, 63% and 58% respectively. CONCLUSION: Our results suggest that diagnostic potential of routine coronary CTA, augmented with CTA based FFR analysis, is superior to ICA in patients with intermediate stenosis.
BACKGROUND: CTA based FFR, a software based application, enhances diagnostic value of coronary computed tomography angiography (CTA) examination. However it remains unknown whether it improves accuracy over the gold standard of invasive coronary angiography (ICA) in predicting functionally significant coronary stenosis. The aim of our study was to compare diagnostic accuracies of coronary CTA, CTA based FFR, and ICA, with invasive FFR as the reference standard in patients with intermediate stenosis on CTA. METHODS: 96 intermediate stenoses (50-90%) from 90 subjects, with intermediate pre-test probability of CAD, who underwent coronary CTA were analyzed. Each patient had subsequent ICA with FFR. CTA based FFR (cFFR v2.1, Siemens) analysis was performed on-site. The stenoses with invasive FFR≤0.8 were considered hemodynamically significant. RESULTS: 41/96 stenoses were hemodynamically significant (FFR≤0.8). While the area under ROC curves (AUC) for identification of significant stenosis evaluated on QCA (0.653), visual ICA (0.652), qCTA (0.690) and visual CTA (0.660) did not significantly differ, the AUC for CTA based FFR (0.835) was significantly higher (p = 0.004, p = 0.004, p = 0.010, p = 0.007, respectively). The accuracies of CTA based FFR, qCTA and QCA were 76%, 63% and 58% respectively. CONCLUSION: Our results suggest that diagnostic potential of routine coronary CTA, augmented with CTA based FFR analysis, is superior to ICA in patients with intermediate stenosis.
Authors: Chris Boyd; Greg Brown; Timothy Kleinig; Joseph Dawson; Mark D McDonnell; Mark Jenkinson; Eva Bezak Journal: Diagnostics (Basel) Date: 2021-03-19