TY - JOUR
T1 - Prediction of Coronary Revascularization in Stable Angina
T2 - Comparison of FFRCT With CMR Stress Perfusion Imaging
AU - Rønnow Sand, Niels Peter
AU - Nissen, Louise
AU - Winther, Simon
AU - Petersen, Steffen E
AU - Westra, Jelmer
AU - Christiansen, Evald H
AU - Larsen, Pia
AU - Holm, Niels R
AU - Isaksen, Christin
AU - Urbonaviciene, Grazina
AU - Deibjerg, Lone
AU - Husain, Majed
AU - Thomsen, Kristian K
AU - Rohold, Allan
AU - Bøtker, Hans Erik
AU - Bøttcher, Morten
N1 - Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.
PY - 2020/4
Y1 - 2020/4
N2 - OBJECTIVES: This study was designed to compare head-to-head fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) and cardiac magnetic resonance (CMR) stress perfusion imaging for prediction of standard-of-care-guided coronary revascularization in patients with stable chest pain and obstructive coronary artery disease by coronary CTA.BACKGROUND: FFRCT is a novel modality for noninvasive functional testing. The clinical utility of FFRCT compared to CMR stress perfusion imaging in symptomatic patients with coronary artery disease is unknown.METHODS: Prospective study of patients (n=110) with stable angina pectoris and 1 or more coronary stenosis ≥50% by coronary CTA. All patients underwent invasive coronary angiography. Revascularization was FFR-guided in stenoses ranging from 30% to 90%. FFRCT ≤0.80 in 1 or more coronary artery or a reversible perfusion defect (≥2 segments) by CMR categorized patients with ischemia. FFRCT and CMR were analyzed by core laboratories blinded for patient management.RESULTS: A total of 38 patients (35%) underwent revascularization. Per-patient diagnostic performance for identifying standard-of-care-guided revascularization, (95% confidence interval) yielded a sensitivity of 97% (86 to 100) for FFRCT versus 47% (31 to 64) for CMR, p < 0.001; corresponding specificity was 42% (30 to 54) versus 88% (78 to 94), p < 0.001; negative predictive value of 97% (91 to 100) versus 76% (67 to 85), p < 0.05; positive predictive value of 47% (36 to 58) versus 67% (49 to 84), p < 0.05; and accuracy of 61% (51 to 70) versus 74% (64 to 82), p > 0.05, respectively.CONCLUSIONS: In patients with stable chest pain referred to invasive coronary angiography based on coronary CTA, FFRCT and CMR yielded similar overall diagnostic accuracy. Sensitivity for prediction of revascularization was highest for FFRCT, whereas specificity was highest for CMR.
AB - OBJECTIVES: This study was designed to compare head-to-head fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) and cardiac magnetic resonance (CMR) stress perfusion imaging for prediction of standard-of-care-guided coronary revascularization in patients with stable chest pain and obstructive coronary artery disease by coronary CTA.BACKGROUND: FFRCT is a novel modality for noninvasive functional testing. The clinical utility of FFRCT compared to CMR stress perfusion imaging in symptomatic patients with coronary artery disease is unknown.METHODS: Prospective study of patients (n=110) with stable angina pectoris and 1 or more coronary stenosis ≥50% by coronary CTA. All patients underwent invasive coronary angiography. Revascularization was FFR-guided in stenoses ranging from 30% to 90%. FFRCT ≤0.80 in 1 or more coronary artery or a reversible perfusion defect (≥2 segments) by CMR categorized patients with ischemia. FFRCT and CMR were analyzed by core laboratories blinded for patient management.RESULTS: A total of 38 patients (35%) underwent revascularization. Per-patient diagnostic performance for identifying standard-of-care-guided revascularization, (95% confidence interval) yielded a sensitivity of 97% (86 to 100) for FFRCT versus 47% (31 to 64) for CMR, p < 0.001; corresponding specificity was 42% (30 to 54) versus 88% (78 to 94), p < 0.001; negative predictive value of 97% (91 to 100) versus 76% (67 to 85), p < 0.05; positive predictive value of 47% (36 to 58) versus 67% (49 to 84), p < 0.05; and accuracy of 61% (51 to 70) versus 74% (64 to 82), p > 0.05, respectively.CONCLUSIONS: In patients with stable chest pain referred to invasive coronary angiography based on coronary CTA, FFRCT and CMR yielded similar overall diagnostic accuracy. Sensitivity for prediction of revascularization was highest for FFRCT, whereas specificity was highest for CMR.
KW - cardiac magnetic resonance stress perfusion imaging
KW - coronary computed tomography angiography–derived fractional flow reserve
KW - revascularization
KW - stable angina
U2 - 10.1016/j.jcmg.2019.06.028
DO - 10.1016/j.jcmg.2019.06.028
M3 - Journal article
C2 - 31422146
SN - 1936-878X
VL - 13
SP - 994
EP - 1004
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 4
ER -