Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Department of Cardiology, Odense University Hospital, Odense, Denmark.
JACC Cardiovasc Imaging. 2018 Nov;11(11):1640-1650. doi: 10.1016/j.jcmg.2018.05.004. Epub 2018 Jun 13.
This study sought to compare the per-patient diagnostic performance of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFR) with that of single-photon emission computed tomography (SPECT), using a fractional flow reserve (FFR) value of ≤0.80 as the reference for diagnosing at least 1 hemodynamically significant stenosis in a head-to-head comparison of patients with intermediate coronary stenosis as determined by coronary CTA.
No previous study has prospectively compared the diagnostic performance of FFR and myocardial perfusion imaging by SPECT in symptomatic patients with intermediate range coronary artery disease (CAD).
This study was conducted at a single-center as a prospective study in patients with stable angina pectoris (N = 143). FFR and SPECT analyses were performed by core laboratories and were blinded for the personnel responsible for downstream patient management. FFR ≤0.80 distally in at least 1 coronary artery with a diameter ≥2 mm classified patients as having ischemia. Ischemia by SPECT was encountered if a reversible perfusion defect (summed difference score ≥2) or transitory ischemic dilation of the left ventricle (ratio >1.19) were found.
The per-patient diagnostic performance for identifying ischemia (95% confidence interval [CI]), FFR versus SPECT, were sensitivity of 91% (95% CI: 81% to 97%) versus 41% (95% CI: 29% to 55%; p < 0.001); specificity of 55% (95% CI: 44% to 66%) versus 86% (95% CI: 77% to 93%; p < 0.001); negative predictive value of 90% (95% CI: 82% to 98%) versus 68% (95% CI: 59% to 77%; p = 0.001); positive predictive value of 58% (95% CI: 48% to 68%) versus 67% (95% CI: 51% to 82%; p = NS); and accuracy of 70% (95% CI: 62% to 77%) versus 68% (95% CI: 60% to 75%; p = NS) respectively.
In patients with stable chest pain and CAD as determined by coronary CTA, the overall diagnostic accuracy levels of FFR and SPECT were identical in assessing hemodynamically significant stenosis. However, FFR demonstrated a significantly higher diagnostic sensitivity than SPECT.
本研究旨在比较冠状动脉计算机断层扫描血管造影（CTA）衍生的血流储备分数（FFR）与单光子发射计算机断层扫描（SPECT）的每例患者诊断性能，以冠状动脉 CTA 确定的中间范围冠状动脉疾病（CAD）患者中至少有 1 个血流动力学显著狭窄的 FFR 值≤0.80 作为诊断参考。
以前没有研究前瞻性比较 FFR 和 SPECT 心肌灌注成像在有症状的中间范围 CAD 患者中的诊断性能。
这项研究在一家单中心进行，是一项稳定型心绞痛患者（N=143）的前瞻性研究。FFR 和 SPECT 分析由核心实验室进行，并对负责下游患者管理的人员进行盲法。至少有 1 个直径≥2mm 的冠状动脉远端 FFR≤0.80 将患者分类为存在缺血。如果发现可逆性灌注缺损（总和差异评分≥2）或左心室短暂性缺血扩张（比值>1.19），则 SPECT 出现缺血。
每例患者的缺血（95%置信区间[CI]）识别诊断性能，FFR 与 SPECT 的比较结果为，敏感性分别为 91%（95%CI：81%至 97%）和 41%（95%CI：29%至 55%；p<0.001）；特异性分别为 55%（95%CI：44%至 66%）和 86%（95%CI：77%至 93%；p<0.001）；阴性预测值分别为 90%（95%CI：82%至 98%）和 68%（95%CI：59%至 77%；p=0.001）；阳性预测值分别为 58%（95%CI：48%至 68%）和 67%（95%CI：51%至 82%；p=NS）；准确性分别为 70%（95%CI：62%至 77%）和 68%（95%CI：60%至 75%；p=NS）。
在通过冠状动脉 CTA 确定的稳定型胸痛和 CAD 患者中，FFR 和 SPECT 的整体诊断准确性水平在评估血流动力学显著狭窄方面相同。然而，FFR 显示出比 SPECT 更高的诊断敏感性。
