Prospective Comparison of FFR Derived From Coronary CT Angiography With SPECT Perfusion Imaging in Stable Coronary Artery Disease: The ReASSESS Study

Niels Peter Rønnow Sand*, Karsten Tange Veien, Søren Steen Nielsen, Bjarne Linde Nørgaard, Pia Larsen, Allan Johansen, Søren Hess, Lone Deibjerg, Majed Husain, Anders Junker, Kristian Korsgaard Thomsen, Allan Rohold, Lisette Okkels Jensen

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Resumé

OBJECTIVES: This study sought to compare the per-patient diagnostic performance of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFR CT) with that of single-photon emission computed tomography (SPECT), using a fractional flow reserve (FFR) value of ≤0.80 as the reference for diagnosing at least 1 hemodynamically significant stenosis in a head-to-head comparison of patients with intermediate coronary stenosis as determined by coronary CTA.

BACKGROUND: No previous study has prospectively compared the diagnostic performance of FFR CT and myocardial perfusion imaging by SPECT in symptomatic patients with intermediate range coronary artery disease (CAD).

METHODS: This study was conducted at a single-center as a prospective study in patients with stable angina pectoris (N = 143). FFR CT and SPECT analyses were performed by core laboratories and were blinded for the personnel responsible for downstream patient management. FFR CT ≤0.80 distally in at least 1 coronary artery with a diameter ≥2 mm classified patients as having ischemia. Ischemia by SPECT was encountered if a reversible perfusion defect (summed difference score ≥2) or transitory ischemic dilation of the left ventricle (ratio >1.19) were found.

RESULTS: The per-patient diagnostic performance for identifying ischemia (95% confidence interval [CI]), FFR CT versus SPECT, were sensitivity of 91% (95% CI: 81% to 97%) versus 41% (95% CI: 29% to 55%; p < 0.001); specificity of 55% (95% CI: 44% to 66%) versus 86% (95% CI: 77% to 93%; p < 0.001); negative predictive value of 90% (95% CI: 82% to 98%) versus 68% (95% CI: 59% to 77%; p = 0.001); positive predictive value of 58% (95% CI: 48% to 68%) versus 67% (95% CI: 51% to 82%; p = NS); and accuracy of 70% (95% CI: 62% to 77%) versus 68% (95% CI: 60% to 75%; p = NS) respectively.

CONCLUSIONS: In patients with stable chest pain and CAD as determined by coronary CTA, the overall diagnostic accuracy levels of FFR CT and SPECT were identical in assessing hemodynamically significant stenosis. However, FFR CT demonstrated a significantly higher diagnostic sensitivity than SPECT.

OriginalsprogEngelsk
TidsskriftJACC: Cardiovascular Imaging
Vol/bind11
Udgave nummer11
Sider (fra-til)1640-1650
ISSN1936-878X
DOI
StatusUdgivet - nov. 2018

Fingeraftryk

Coronary Angiography
Coronary Artery Disease
Confidence Intervals
Pathologic Constriction
Computed Tomography Angiography
Stable Angina
Heart Ventricles
Dilatation
Perfusion
Prospective Studies

Citer dette

@article{6666ef052f6e48e3bc142888e012b350,
title = "Prospective Comparison of FFR Derived From Coronary CT Angiography With SPECT Perfusion Imaging in Stable Coronary Artery Disease: The ReASSESS Study",
abstract = "OBJECTIVES: This study sought to compare the per-patient diagnostic performance of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFR CT) with that of single-photon emission computed tomography (SPECT), using a fractional flow reserve (FFR) value of ≤0.80 as the reference for diagnosing at least 1 hemodynamically significant stenosis in a head-to-head comparison of patients with intermediate coronary stenosis as determined by coronary CTA. BACKGROUND: No previous study has prospectively compared the diagnostic performance of FFR CT and myocardial perfusion imaging by SPECT in symptomatic patients with intermediate range coronary artery disease (CAD). METHODS: This study was conducted at a single-center as a prospective study in patients with stable angina pectoris (N = 143). FFR CT and SPECT analyses were performed by core laboratories and were blinded for the personnel responsible for downstream patient management. FFR CT ≤0.80 distally in at least 1 coronary artery with a diameter ≥2 mm classified patients as having ischemia. Ischemia by SPECT was encountered if a reversible perfusion defect (summed difference score ≥2) or transitory ischemic dilation of the left ventricle (ratio >1.19) were found. RESULTS: The per-patient diagnostic performance for identifying ischemia (95{\%} confidence interval [CI]), FFR CT versus SPECT, were sensitivity of 91{\%} (95{\%} CI: 81{\%} to 97{\%}) versus 41{\%} (95{\%} CI: 29{\%} to 55{\%}; p < 0.001); specificity of 55{\%} (95{\%} CI: 44{\%} to 66{\%}) versus 86{\%} (95{\%} CI: 77{\%} to 93{\%}; p < 0.001); negative predictive value of 90{\%} (95{\%} CI: 82{\%} to 98{\%}) versus 68{\%} (95{\%} CI: 59{\%} to 77{\%}; p = 0.001); positive predictive value of 58{\%} (95{\%} CI: 48{\%} to 68{\%}) versus 67{\%} (95{\%} CI: 51{\%} to 82{\%}; p = NS); and accuracy of 70{\%} (95{\%} CI: 62{\%} to 77{\%}) versus 68{\%} (95{\%} CI: 60{\%} to 75{\%}; p = NS) respectively. CONCLUSIONS: In patients with stable chest pain and CAD as determined by coronary CTA, the overall diagnostic accuracy levels of FFR CT and SPECT were identical in assessing hemodynamically significant stenosis. However, FFR CT demonstrated a significantly higher diagnostic sensitivity than SPECT.",
keywords = "coronary CTA, FFR, SPECT myocardial perfusion imaging, stable angina",
author = "Sand, {Niels Peter R{\o}nnow} and Veien, {Karsten Tange} and Nielsen, {S{\o}ren Steen} and N{\o}rgaard, {Bjarne Linde} and Pia Larsen and Allan Johansen and S{\o}ren Hess and Lone Deibjerg and Majed Husain and Anders Junker and Thomsen, {Kristian Korsgaard} and Allan Rohold and Jensen, {Lisette Okkels}",
year = "2018",
month = "11",
doi = "10.1016/j.jcmg.2018.05.004",
language = "English",
volume = "11",
pages = "1640--1650",
journal = "J A C C: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier",
number = "11",

}

TY - JOUR

T1 - Prospective Comparison of FFR Derived From Coronary CT Angiography With SPECT Perfusion Imaging in Stable Coronary Artery Disease

T2 - The ReASSESS Study

AU - Sand, Niels Peter Rønnow

AU - Veien, Karsten Tange

AU - Nielsen, Søren Steen

AU - Nørgaard, Bjarne Linde

AU - Larsen, Pia

AU - Johansen, Allan

AU - Hess, Søren

AU - Deibjerg, Lone

AU - Husain, Majed

AU - Junker, Anders

AU - Thomsen, Kristian Korsgaard

AU - Rohold, Allan

AU - Jensen, Lisette Okkels

PY - 2018/11

Y1 - 2018/11

N2 - OBJECTIVES: This study sought to compare the per-patient diagnostic performance of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFR CT) with that of single-photon emission computed tomography (SPECT), using a fractional flow reserve (FFR) value of ≤0.80 as the reference for diagnosing at least 1 hemodynamically significant stenosis in a head-to-head comparison of patients with intermediate coronary stenosis as determined by coronary CTA. BACKGROUND: No previous study has prospectively compared the diagnostic performance of FFR CT and myocardial perfusion imaging by SPECT in symptomatic patients with intermediate range coronary artery disease (CAD). METHODS: This study was conducted at a single-center as a prospective study in patients with stable angina pectoris (N = 143). FFR CT and SPECT analyses were performed by core laboratories and were blinded for the personnel responsible for downstream patient management. FFR CT ≤0.80 distally in at least 1 coronary artery with a diameter ≥2 mm classified patients as having ischemia. Ischemia by SPECT was encountered if a reversible perfusion defect (summed difference score ≥2) or transitory ischemic dilation of the left ventricle (ratio >1.19) were found. RESULTS: The per-patient diagnostic performance for identifying ischemia (95% confidence interval [CI]), FFR CT versus SPECT, were sensitivity of 91% (95% CI: 81% to 97%) versus 41% (95% CI: 29% to 55%; p < 0.001); specificity of 55% (95% CI: 44% to 66%) versus 86% (95% CI: 77% to 93%; p < 0.001); negative predictive value of 90% (95% CI: 82% to 98%) versus 68% (95% CI: 59% to 77%; p = 0.001); positive predictive value of 58% (95% CI: 48% to 68%) versus 67% (95% CI: 51% to 82%; p = NS); and accuracy of 70% (95% CI: 62% to 77%) versus 68% (95% CI: 60% to 75%; p = NS) respectively. CONCLUSIONS: In patients with stable chest pain and CAD as determined by coronary CTA, the overall diagnostic accuracy levels of FFR CT and SPECT were identical in assessing hemodynamically significant stenosis. However, FFR CT demonstrated a significantly higher diagnostic sensitivity than SPECT.

AB - OBJECTIVES: This study sought to compare the per-patient diagnostic performance of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFR CT) with that of single-photon emission computed tomography (SPECT), using a fractional flow reserve (FFR) value of ≤0.80 as the reference for diagnosing at least 1 hemodynamically significant stenosis in a head-to-head comparison of patients with intermediate coronary stenosis as determined by coronary CTA. BACKGROUND: No previous study has prospectively compared the diagnostic performance of FFR CT and myocardial perfusion imaging by SPECT in symptomatic patients with intermediate range coronary artery disease (CAD). METHODS: This study was conducted at a single-center as a prospective study in patients with stable angina pectoris (N = 143). FFR CT and SPECT analyses were performed by core laboratories and were blinded for the personnel responsible for downstream patient management. FFR CT ≤0.80 distally in at least 1 coronary artery with a diameter ≥2 mm classified patients as having ischemia. Ischemia by SPECT was encountered if a reversible perfusion defect (summed difference score ≥2) or transitory ischemic dilation of the left ventricle (ratio >1.19) were found. RESULTS: The per-patient diagnostic performance for identifying ischemia (95% confidence interval [CI]), FFR CT versus SPECT, were sensitivity of 91% (95% CI: 81% to 97%) versus 41% (95% CI: 29% to 55%; p < 0.001); specificity of 55% (95% CI: 44% to 66%) versus 86% (95% CI: 77% to 93%; p < 0.001); negative predictive value of 90% (95% CI: 82% to 98%) versus 68% (95% CI: 59% to 77%; p = 0.001); positive predictive value of 58% (95% CI: 48% to 68%) versus 67% (95% CI: 51% to 82%; p = NS); and accuracy of 70% (95% CI: 62% to 77%) versus 68% (95% CI: 60% to 75%; p = NS) respectively. CONCLUSIONS: In patients with stable chest pain and CAD as determined by coronary CTA, the overall diagnostic accuracy levels of FFR CT and SPECT were identical in assessing hemodynamically significant stenosis. However, FFR CT demonstrated a significantly higher diagnostic sensitivity than SPECT.

KW - coronary CTA

KW - FFR

KW - SPECT myocardial perfusion imaging

KW - stable angina

U2 - 10.1016/j.jcmg.2018.05.004

DO - 10.1016/j.jcmg.2018.05.004

M3 - Journal article

C2 - 29909103

AN - SCOPUS:85048595771

VL - 11

SP - 1640

EP - 1650

JO - J A C C: Cardiovascular Imaging

JF - J A C C: Cardiovascular Imaging

SN - 1936-878X

IS - 11

ER -