CT Myocardial Perfusion and CT-FFR versus Invasive FFR for Hemodynamic Relevance of Coronary Artery Disease

医学 部分流量储备 心脏病学 冠状动脉疾病 灌注 内科学 灌注扫描 狭窄 血管造影 放射科 心肌灌注成像 冠状动脉造影 心肌梗塞
作者
Martin Soschynski,Roberto Storelli,Clara Birkemeyer,Muhammad Taha Hagar,Sebastian Faby,Chris Schwemmer,Fay M.A. Nous,Francesca Pugliese,Rozemarijn Vliegenthart,Christopher L. Schlett,Konstantin Nikolaou,Patrick Krumm,Koen Nieman,Fabian Bamberg,Christoph Artzner
出处
期刊:Radiology [Radiological Society of North America]
卷期号:312 (2) 被引量:4
标识
DOI:10.1148/radiol.233234
摘要

Background CT-derived fractional flow reserve (CT-FFR) and dynamic CT myocardial perfusion imaging enhance the specificity of coronary CT angiography (CCTA) for ruling out coronary artery disease (CAD). However, evidence on comparative diagnostic value remains scarce. Purpose To compare the diagnostic accuracy of CCTA plus CT-FFR, CCTA plus CT perfusion, and sequential CCTA plus CT-FFR and CT perfusion for detecting hemodynamically relevant CAD with that of invasive angiography. Materials and Methods This secondary analysis of a prospective study included patients with chest pain referred for invasive coronary angiography at nine centers from July 2016 to September 2019. CCTA and CT perfusion were performed with third-generation dual-source CT scanners. CT-FFR was assessed on-site. Independent core laboratories analyzed CCTA alone, CCTA plus CT perfusion, CCTA plus CT-FFR, and a sequential approach involving CCTA plus CT-FFR and CT perfusion for the presence of hemodynamically relevant stenosis. Invasive coronary angiography with invasive fractional flow reserve was the reference standard. Diagnostic accuracy metrics and the area under the receiver operating characteristic curve (AUC) were compared with the Sign test and DeLong test. Results Of the 105 participants (mean age, 64 years ± 8 [SD]; 68 male), 49 (47%) had hemodynamically relevant stenoses at invasive coronary angiography. CCTA plus CT-FFR and CCTA plus CT perfusion showed no evidence of a difference for participant-based sensitivities (90% vs 90%,
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