Roel S Driessen1, Ibrahim Danad1, Wijnand J Stuijfzand1, Pieter G Raijmakers2, Stefan P Schumacher1, Pepijn A van Diemen1, Jonathon A Leipsic3, Juhani Knuuti4, S Richard Underwood5, Peter M van de Ven6, Albert C van Rossum1, Charles A Taylor7, Paul Knaapen8. 1. Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands. 2. Department of Radiology, Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, the Netherlands. 3. Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada. 4. Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland. 5. Department of Nuclear Medicine, Royal Brompton Hospital, London, United Kingdom. 6. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands. 7. HeartFlow, Inc., Redwood City, California; Department of Bioengineering, Stanford University, Stanford, California. 8. Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands. Electronic address: p.knaapen@vumc.nl.
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-to-diagnose 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.
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-to-diagnose 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.
Authors: Maros Ferencik; Michael T Lu; Thomas Mayrhofer; Stefan B Puchner; Ting Liu; Pal Maurovich-Horvat; Khristine Ghemigian; Alexander Ivanov; Elizabeth Adami; John T Nagurney; Pamela K Woodard; Quynh A Truong; James E Udelson; Udo Hoffmann Journal: J Cardiovasc Comput Tomogr Date: 2019-05-15
Authors: Andrew Lin; Márton Kolossváry; Manish Motwani; Ivana Išgum; Pál Maurovich-Horvat; Piotr J Slomka; Damini Dey Journal: Radiol Cardiothorac Imaging Date: 2021-02-25
Authors: Habib Samady; David S Molony; Ahmet U Coskun; Anubodh S Varshney; Bernard De Bruyne; Peter H Stone Journal: J Cardiovasc Comput Tomogr Date: 2019-12-04
Authors: Domingo E Uceda; Amit K Dey; Sundus S Lateef; Khaled Abdelrahman; Milena Aksentijevich; Aarthi S Reddy; Harry Choi; Justin A Rodante; Martin P Playford; David A Bluemke; Wunan Zhou; Marcus Y Chen; Joel M Gelfand; Nehal N Mehta Journal: J Invest Dermatol Date: 2020-10-01 Impact factor: 8.551
Authors: Khaled M Abdelrahman; Marcus Y Chen; Amit K Dey; Renu Virmani; Aloke V Finn; Ramzi Y Khamis; Andrew D Choi; James K Min; Michelle C Williams; Andrew J Buckler; Charles A Taylor; Campbell Rogers; Habib Samady; Charalambos Antoniades; Leslee J Shaw; Matthew J Budoff; Udo Hoffmann; Ron Blankstein; Jagat Narula; Nehal N Mehta Journal: J Am Coll Cardiol Date: 2020-09-08 Impact factor: 24.094