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
SN - 1936-878X
VL - 11
SP - 1640
EP - 1650
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 11
ER -