Nakanishi Rine, Matsumoto Suguru, Alani Anas, Li Dong, Kitslaar Pieter H, Broersen Alexander, Koo Bon-Kwon, Min James K, Budoff Matthew J
Los Angeles Biomedical Research Center at Harbor UCLA Medical Center, Torrance, CA, USA.
Int J Cardiovasc Imaging. 2015 Aug;31(6):1251-9. doi: 10.1007/s10554-015-0666-2. Epub 2015 Apr 24.
Although coronary computed tomographic angiography (CCTA) has been a robust diagnostic tool to identify anatomical significance of coronary artery disease (CAD), the utility of CCTA to assess hemodynamic significance of CAD remains unclear. We investigated the diagnostic performance of transluminal attenuation gradient (TAG) and fractional flow reserve derived from CCTA (FFRCT) to predict lesion-specific ischemia by invasive FFR. We identified 103 patients with suspected or known CAD enrolled from the DISCOVER-FLOW and DeFACTO studies who underwent invasive coronary angiography with FFR and high quality ≥64-slice CCTA. Diagnostic performance for predicting abnormal invasive FFR (≤0.80) was assessed for TAG [≤-1.1 HU/mm by the area under the curve (AUC) by receiver-operating characteristic curve analysis (ROC)], FFR(CT) (≤0.80), and CCTA stenosis (≥50%). On a per-vessel analysis (n = 146), 52 vessels (35.6%) had ischemia by invasive FFR. The sensitivity, specificity, positive predictive value and negative predictive value were 53.8, 45.7, 35.4, 64.2% for TAG, 82.7, 74.5, 64.2, 88.6% for FFR(CT), 84.6, 39.4, 43.6, 82.2% for CCTA stenosis, respectively. The AUC by ROC curve analysis for FFR(CT) (0.79) demonstrated greater discrimination of hemodynamic ischemia compared to TAG (0.50, p < 0.0001 vs. FFR(CT)), CCTA stenosis (0.62, p = 0.0004 vs. FFR(CT)) and the combination of the two (0.63, p = 0.004 vs. FFR(CT)). These results remained consistent regardless of the number of CCTA slices. FFR(CT) allows identification of lesion-specific ischemia using invasive FFR as a reference standard with greater diagnostic accuracy than TAG, CCTA stenosis, or the combination of the two.
尽管冠状动脉计算机断层血管造影（CCTA）一直是识别冠状动脉疾病（CAD）解剖学意义的强大诊断工具，但CCTA评估CAD血流动力学意义的效用仍不明确。我们研究了管腔衰减梯度（TAG）和源自CCTA的血流储备分数（FFRCT）预测通过有创FFR检测的病变特异性缺血的诊断性能。我们从DISCOVER-FLOW和DeFACTO研究中纳入了103例疑似或已知CAD的患者，这些患者接受了有创冠状动脉造影及FFR检查和高质量的≥64层CCTA检查。通过受试者操作特征曲线分析（ROC）的曲线下面积（AUC）评估TAG[≤-1.1 HU/mm]、FFR(CT)（≤0.80）和CCTA狭窄（≥50%）预测异常有创FFR（≤0.80）的诊断性能。在每支血管分析中（n = 146），52支血管（35.6%）通过有创FFR检测存在缺血。TAG的敏感性、特异性、阳性预测值和阴性预测值分别为53.8%、45.7%、35.4%、64.2%；FFR(CT)分别为82.7%、74.5%、64.2%、88.6%；CCTA狭窄分别为84.6%、39.4%、43.6%、82.2%。通过ROC曲线分析，FFR(CT)的AUC（0.79）显示与TAG（0.50，与FFR(CT)相比p < 0.0001）、CCTA狭窄（0.62，与FFR(CT)相比p = 0.0004）以及两者联合（0.63，与FFR(CT)相比p = 0.004）相比，对血流动力学缺血具有更大的鉴别能力。无论CCTA的层数如何，这些结果均保持一致。以有创FFR作为参考标准，FFR(CT)能够识别病变特异性缺血，其诊断准确性高于TAG、CCTA狭窄或两者联合。
