Prediction of Coronary Revascularization in Stable Angina: Comparison of FFRCT With CMR Stress Perfusion Imaging

Niels Peter Rønnow Sand, Louise Nissen, Simon Winther, Steffen E Petersen, Jelmer Westra, Evald H Christiansen, Pia Larsen, Niels R Holm, Christin Isaksen, Grazina Urbonaviciene, Lone Deibjerg, Majed Husain, Kristian K Thomsen, Allan Rohold, Hans Erik Bøtker, Morten Bøttcher

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

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.

Original languageEnglish
JournalJ A C C: Cardiovascular Imaging
ISSN1936-878X
DOIs
Publication statusE-pub ahead of print - 8. Aug 2019

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Stable Angina
Magnetic Resonance Angiography
Coronary Angiography
Coronary Artery Disease
Pathologic Constriction
Perfusion
Prospective Studies
Confidence Intervals
Computed Tomography Angiography

Cite this

Rønnow Sand, Niels Peter ; Nissen, Louise ; Winther, Simon ; Petersen, Steffen E ; Westra, Jelmer ; Christiansen, Evald H ; Larsen, Pia ; Holm, Niels R ; Isaksen, Christin ; Urbonaviciene, Grazina ; Deibjerg, Lone ; Husain, Majed ; Thomsen, Kristian K ; Rohold, Allan ; Bøtker, Hans Erik ; Bøttcher, Morten. / Prediction of Coronary Revascularization in Stable Angina : Comparison of FFRCT With CMR Stress Perfusion Imaging. In: J A C C: Cardiovascular Imaging. 2019.
@article{f9b6904373144bffadeee9fcb74b1cbe,
title = "Prediction of Coronary Revascularization in Stable Angina: Comparison of FFRCT With CMR Stress Perfusion Imaging",
abstract = "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.",
author = "{R{\o}nnow Sand}, {Niels Peter} and Louise Nissen and Simon Winther and Petersen, {Steffen E} and Jelmer Westra and Christiansen, {Evald H} and Pia Larsen and Holm, {Niels R} and Christin Isaksen and Grazina Urbonaviciene and Lone Deibjerg and Majed Husain and Thomsen, {Kristian K} and Allan Rohold and B{\o}tker, {Hans Erik} and Morten B{\o}ttcher",
note = "Copyright {\circledC} 2019 The Authors. Published by Elsevier Inc. All rights reserved.",
year = "2019",
month = "8",
day = "8",
doi = "10.1016/j.jcmg.2019.06.028",
language = "English",
journal = "J A C C: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier",

}

Rønnow Sand, NP, Nissen, L, Winther, S, Petersen, SE, Westra, J, Christiansen, EH, Larsen, P, Holm, NR, Isaksen, C, Urbonaviciene, G, Deibjerg, L, Husain, M, Thomsen, KK, Rohold, A, Bøtker, HE & Bøttcher, M 2019, 'Prediction of Coronary Revascularization in Stable Angina: Comparison of FFRCT With CMR Stress Perfusion Imaging', J A C C: Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2019.06.028

Prediction of Coronary Revascularization in Stable Angina : Comparison of FFRCT With CMR Stress Perfusion Imaging. / Rønnow Sand, Niels Peter; Nissen, Louise; Winther, Simon; Petersen, Steffen E; Westra, Jelmer; Christiansen, Evald H; Larsen, Pia; Holm, Niels R; Isaksen, Christin; Urbonaviciene, Grazina; Deibjerg, Lone; Husain, Majed; Thomsen, Kristian K; Rohold, Allan; Bøtker, Hans Erik; Bøttcher, Morten.

In: J A C C: Cardiovascular Imaging, 08.08.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

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 - 2019/8/8

Y1 - 2019/8/8

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.

U2 - 10.1016/j.jcmg.2019.06.028

DO - 10.1016/j.jcmg.2019.06.028

M3 - Journal article

C2 - 31422146

JO - J A C C: Cardiovascular Imaging

JF - J A C C: Cardiovascular Imaging

SN - 1936-878X

ER -