Abstract
Purpose: To compare the diagnostic performance of estimated energy loss (EEL) calculated using a simplified Bernoulli formula at coronary computed tomography (CT) and single photon emission computed tomography (SPECT) to diagnose ischemia-causing stenosis by invasive fractional flow reserve (FFR). Methods: We retrospectively included 43 patients who underwent coronary CT, SPECT, and FFR measurement by catheter within 3 months. When an intermediate stenosis (40% - 70%) was present at CT, EEL was calculated using the following parameters: lesion length, diameter stenosis, minimal lumen area, and the myocardial volume. An EEL > 1.17 or diameter stenosis > 70% was determined ischemic. Stress-induced ischemia by SPECT was determined when a perfusion defect at stress was accompanied with a fill-in at rest. An FFR ≤ 0.80 or diameter stenosis >70 % was determined as ischemic by catheter. Results: A total of 26 vessels were determined as ischemic by catheter exam. The per-vessel sensitivity and specificity of EEL and SPECT were 81% vs 42% and 92% vs 91%, respectively. The accuracy of EEL to diagnose stenosis causing ischemia was significantly higher than SPECT (90% vs 81%, p = 0.04). The area under the curve of the receiver operating characteristics curve was also significantly higher for EEL than SPECT (0.86 vs 0.67, p < 0.005). Conclusions: EEL showed higher accuracy than SPECT to diagnose ischemia-causing stenosis by improving the sensitivity.
Highlights
Growing evidence has shown that coronary artery disease treated based on functional ischemia improves the patient outcome than anatomically-guided methods [1]
The accuracy of energy loss (EEL) to diagnose stenosis causing ischemia was significantly higher than single photon emission computed tomography (SPECT) (90% vs 81%, p = 0.04)
fractional flow reserve (FFR) derived from computed tomography (CT) could correctly predict ischemia by invasive FFR with an accuracy of 80% [2], coronary CT data needs to be transferred to an external supercomputer and turn-around time is necessary
Summary
Growing evidence has shown that coronary artery disease treated based on functional ischemia improves the patient outcome than anatomically-guided methods [1]. FFR derived from CT could correctly predict ischemia by invasive FFR with an accuracy of 80% [2], coronary CT data needs to be transferred to an external supercomputer and turn-around time is necessary. Simplified Bernoulli formula is frequently used at echocardiography to estimate the pressure loss across a valvular stenosis This method could be used to calculate estimated energy loss (EEL), which is an index to estimate the pressure loss across a coronary stenosis. A previous study showed that EEL could correctly predict ischemia assessed by FFR with an accuracy of 83% [3].
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