Abstract
Coronary computed tomography angiography (CCTA) in combination with first-pass CT myocardial perfusion imaging (MPI) has a better diagnostic performance than CCTA alone, compared with invasive coronary angiography as the reference standard. The aim of this study was to investigate the additional diagnostic value of first-pass CT-MPI without stress for detecting hemodynamic significance of coronary stenosis, compared with invasive fractional flow reserve (FFR). We recruited 53 patients with suspected coronary artery disease undergoing both CCTA and first-pass CT-MPI without stress and invasive FFR, and 75 vessels were analyzed. We used the same raw data for CCTA and CT-MPI. First-pass CT-MPI was reconstructed by examining the diastolic signal densities as a bull’s eye map. Invasive FFR <0.8 was considered as positive. On per-vessel analysis, the area under the receiver operating characteristic curve for CCTA plus first-pass CT-MPI and CCTA alone was 0.81 (0.73–0.90) and 0.70 (0.61–0.81), respectively (P = 0.036). CCTA plus first-pass CT-MPI without stress showed 0.73 sensitivity, 0.74 specificity, 0.53 positive predictive value, and 0.87 negative predictive value for detecting hemodynamically significant coronary stenosis. First-pass CT-MPI without stress correctly reclassified 38% of CCTA false-positive vessels as true negative. First-pass CT-MPI without stress combined with CCTA demonstrated excellent diagnostic accuracy, compared with invasive FFR as the reference standard. This technique could complement CCTA for diagnosis of coronary artery disease.
Highlights
Coronary computed tomography angiography (CCTA) is an excellent method for detecting coronary artery disease (CAD), it is still challenging in cases with heavy calcification and intermediate stenotic lesions.[1]
We have recently reported the usefulness of first-pass CT-myocardial perfusion imaging (MPI) without stress in combination with CCTA for diagnosis of obstructive CAD, compared with CCTA alone, with invasive coronary angiography (ICA) as the reference standard.[2]
Invasive coronary angiography is a gold standard for anatomical detection of obstructive CAD, it has limited capacity to determine the hemodynamic significance of stenosis, which is determined by decreased fractional flow reserve (FFR).[3, 4]
Summary
Coronary computed tomography angiography (CCTA) is an excellent method for detecting coronary artery disease (CAD), it is still challenging in cases with heavy calcification and intermediate stenotic lesions.[1]. We have recently reported the usefulness of first-pass CT-MPI without stress in combination with CCTA for diagnosis of obstructive CAD, compared with CCTA alone, with invasive coronary angiography (ICA) as the reference standard.[2] Invasive coronary angiography is a gold standard for anatomical detection of obstructive CAD, it has limited capacity to determine the hemodynamic significance of stenosis, which is determined by decreased fractional flow reserve (FFR).[3, 4]. Measurement of FFR by ICA is the gold standard for diagnosis of coronary stenosis causing lesion-specific ischemia.[5] The FAME (Fractional Flow Reserve vs Angiography for Multivessel Evaluation) study has shown that invasive FFR-guided decisions about revascularization improve event-free survival compared with coronary angiography-guided decisions alone.[6] FFR is the accepted reference standard for assessing the functional significance of CAD in a lesion-specific manner.[7] The use of FFR, is inherently limited by its invasiveness and costs. These issues underscore the need for more accurate noninvasive diagnostic tests for gatekeeping to the catheterization laboratory
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