Coronary Artery Disease and Structural Heart Disease Department, Institute of Cardiology, Alpejska 42 St, 04-628, Warsaw, Poland.
Coronary Artery Disease and Structural Heart Disease Department, Institute of Cardiology, Alpejska 42 St, 04-628, Warsaw, Poland; Laboratory of Noninvasive Diagnostics of Coronary Artery Disease, Institute of Cardiology, Alpejska 42 St, 04-628, Warsaw, Poland.
J Cardiovasc Comput Tomogr. 2019 Jan-Feb;13(1):62-67. doi: 10.1016/j.jcct.2018.10.004. Epub 2018 Oct 2.
CTA based FFR, a software based application, enhances diagnostic value of coronary computed tomography angiography (CTA) examination. However it remains unknown whether it improves accuracy over the gold standard of invasive coronary angiography (ICA) in predicting functionally significant coronary stenosis. The aim of our study was to compare diagnostic accuracies of coronary CTA, CTA based FFR, and ICA, with invasive FFR as the reference standard in patients with intermediate stenosis on CTA.
96 intermediate stenoses (50-90%) from 90 subjects, with intermediate pre-test probability of CAD, who underwent coronary CTA were analyzed. Each patient had subsequent ICA with FFR. CTA based FFR (cFFR v2.1, Siemens) analysis was performed on-site. The stenoses with invasive FFR≤0.8 were considered hemodynamically significant.
41/96 stenoses were hemodynamically significant (FFR≤0.8). While the area under ROC curves (AUC) for identification of significant stenosis evaluated on QCA (0.653), visual ICA (0.652), qCTA (0.690) and visual CTA (0.660) did not significantly differ, the AUC for CTA based FFR (0.835) was significantly higher (p = 0.004, p = 0.004, p = 0.010, p = 0.007, respectively). The accuracies of CTA based FFR, qCTA and QCA were 76%, 63% and 58% respectively.
Our results suggest that diagnostic potential of routine coronary CTA, augmented with CTA based FFR analysis, is superior to ICA in patients with intermediate stenosis.
CTA 基础 FFR，一种基于软件的应用，提高了冠状动脉计算机断层扫描血管造影（CTA）检查的诊断价值。然而，它是否能提高对预测功能性冠状动脉狭窄的金标准——有创冠状动脉造影（ICA）的准确性仍不清楚。我们的研究目的是比较 CTA、CTA 基础 FFR 和 ICA 在 CTA 显示中度狭窄的患者中的诊断准确性，以有创 FFR 为参考标准。
对 90 例中度狭窄（50-90%）的患者进行了 96 个冠状动脉 CTA 分析，这些患者有中度 CAD 术前概率，随后进行了 ICA 和 FFR。在现场进行了 CTA 基础 FFR（cFFR v2.1，西门子）分析。以有创 FFR≤0.8 的狭窄为有血流动力学意义的狭窄。
96 个狭窄中有 41 个为有血流动力学意义的狭窄（FFR≤0.8）。虽然 QCA（0.653）、视觉 ICA（0.652）、qCTA（0.690）和视觉 CTA（0.660）评估的显著狭窄的 ROC 曲线下面积（AUC）没有显著差异，但 CTA 基础 FFR（0.835）的 AUC 显著更高（p=0.004，p=0.004，p=0.010，p=0.007，分别）。CTA 基础 FFR、qCTA 和 QCA 的准确性分别为 76%、63%和 58%。
我们的结果表明，在中度狭窄的患者中，常规冠状动脉 CTA 与 CTA 基础 FFR 分析相结合的诊断潜力优于 ICA。
