Monash Cardiovascular Research Centre, MonashHEART, Department of Medicine Monash Medical Centre (MMC), Southern Health and Monash University, Melbourne, Australia,
Eur Radiol. 2014 Mar;24(3):738-47. doi: 10.1007/s00330-013-3059-8. Epub 2013 Nov 12.
To determine the accuracy of 320-row multidetector coronary computed tomography angiography (M320-CCTA) to detect functional stenoses using fractional flow reserve (FFR) as the reference standard and to predict revascularisation in stable coronary artery disease.
One hundred and fifteen patients (230 vessels) underwent M320-CCTA and FFR assessment and were followed for 18 months. Diameter stenosis on invasive angiography (ICA) and M320-CCTA were assessed by consensus by two observers and significant stenosis was defined as ≥50%. FFR ≤0.8 indicated functionally significant stenoses.
M320-CCTA had 94% sensitivity and 94% negative predictive value (NPV) for FFR ≤0.8. Overall accuracy was 70%, specificity 54% and positive predictive value 65%. On receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) for CCTA to predict FFR ≤0.8 was 0.74 which was comparable with ICA. The absence of a significant stenosis on M320-CCTA was associated with a 6% revascularisation rate. M320-CCTA predicted revascularisation with an AUC of 0.71 which was comparable with ICA.
M320-CCTA has excellent sensitivity and NPV for functional stenoses and therefore may act as an effective gatekeeper to defer ICA and revascularisation. Like ICA, M320-CCTA lacks specificity for functional stenoses and only has moderate accuracy to predict the need for revascularisation.
• Important information about the heart is provided by 320-row multidetector CT coronary angiography (M320-CCTA). • M320-CCTA accurately detects and excludes functional stenoses determined by fractional flow reserve (FFR). • Non-significant stenoses on M320-CCTA associated with fewer cardiac events and less revascularisation. • M320-CCTA may act as a gatekeeper for invasive angiography and inappropriate revascularisation. • Like ICA, M320-CCTA only has moderate accuracy to predict vessels requiring revascularisation.
利用血流储备分数（FFR）作为参考标准，评估 320 层多排螺旋 CT 冠状动脉成像（M320-CCTA）检测功能性狭窄的准确性，并预测稳定性冠心病的血运重建情况。
115 例患者（230 支血管）接受 M320-CCTA 和 FFR 评估，并随访 18 个月。两位观察者通过共识评估血管内造影（ICA）和 M320-CCTA 的直径狭窄程度，并定义狭窄程度≥50%为显著狭窄。FFR≤0.8 提示功能性狭窄。
M320-CCTA 对 FFR≤0.8 的检测具有 94%的敏感性和 94%的阴性预测值（NPV）。总体准确性为 70%，特异性为 54%，阳性预测值为 65%。在接受者操作特征（ROC）曲线分析中，CCTA 预测 FFR≤0.8 的曲线下面积（AUC）为 0.74，与 ICA 相当。M320-CCTA 未见显著狭窄与 6%的血运重建率相关。M320-CCTA 预测血运重建的 AUC 为 0.71，与 ICA 相当。
M320-CCTA 对功能性狭窄具有出色的敏感性和 NPV，因此可能作为一种有效的“守门员”，推迟 ICA 和血运重建。与 ICA 一样，M320-CCTA 对功能性狭窄缺乏特异性，仅具有中等准确性来预测血运重建的需求。
320 层多排螺旋 CT 冠状动脉成像（M320-CCTA）提供了有关心脏的重要信息。
M320-CCTA 准确检测并排除由血流储备分数（FFR）确定的功能性狭窄。
M320-CCTA 未见狭窄与较少的心脏事件和较少的血运重建相关。
M320-CCTA 可能作为有创血管造影和不适当血运重建的“守门员”。
与 ICA 一样，M320-CCTA 仅具有中等准确性来预测需要血运重建的血管。
