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Diagnostic Performance of Noninvasive Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography in Suspected Coronary Artery Disease

部分流量储备 医学 冠状动脉疾病 血运重建 心脏病学 放射科 接收机工作特性 内科学 狭窄 金标准(测试) 血管造影 曲线下面积 冠状动脉造影 计算机断层血管造影 心肌梗塞
作者
Bjarne Linde Nørgaard,Jonathon Leipsic,Sara Gaur,S. Seneviratne,Brian Ko,Hiroshi Ito,Jesper Møller Jensen,Laura Mauri,Bernard De Bruyne,Hiram G. Bezerra,Kazuhiro Osawa,Mohamed Marwan,Christoph Naber,Andrejs Ērglis,Seung‐Jung Park,Evald Høj Christiansen,Anne Kaltoft,Jens Flensted Lassen,Hans Erik Bøtker,Stephan Achenbach
出处
期刊:Journal of the American College of Cardiology [Elsevier BV]
卷期号:63 (12): 1145-1155 被引量:1238
标识
DOI:10.1016/j.jacc.2013.11.043
摘要

The goal of this study was to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFRCT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD). FFR measured during invasive coronary angiography (ICA) is the gold standard for lesion-specific coronary revascularization decisions in patients with stable CAD. The potential for FFRCT to noninvasively identify ischemia in patients with suspected CAD has not been sufficiently investigated. This prospective multicenter trial included 254 patients scheduled to undergo clinically indicated ICA for suspected CAD. Coronary CTA was performed before ICA. Evaluation of stenosis (>50% lumen reduction) in coronary CTA was performed by local investigators and in ICA by an independent core laboratory. FFRCT was calculated and interpreted in a blinded fashion by an independent core laboratory. Results were compared with invasively measured FFR, with ischemia defined as FFRCT or FFR ≤0.80. The area under the receiver-operating characteristic curve for FFRCT was 0.90 (95% confidence interval [CI]: 0.87 to 0.94) versus 0.81 (95% CI: 0.76 to 0.87) for coronary CTA (p = 0.0008). Per-patient sensitivity and specificity (95% CI) to identify myocardial ischemia were 86% (95% CI: 77% to 92%) and 79% (95% CI: 72% to 84%) for FFRCT versus 94% (86 to 97) and 34% (95% CI: 27% to 41%) for coronary CTA, and 64% (95% CI: 53% to 74%) and 83% (95% CI: 77% to 88%) for ICA, respectively. In patients (n = 235) with intermediate stenosis (95% CI: 30% to 70%), the diagnostic accuracy of FFRCT remained high. FFRCT provides high diagnostic accuracy and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. When compared with anatomic testing by using coronary CTA, FFRCT led to a marked increase in specificity. (HeartFlowNXT–HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography [HFNXT]; NCT01757678)
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