Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
JACC Cardiovasc Imaging. 2019 Aug;12(8 Pt 1):1487-1497. doi: 10.1016/j.jcmg.2018.08.023. Epub 2018 Oct 17.
This study sought to compare the diagnostic accuracy of coronary computed tomography angiography (cCTA) with that of cCTA+fractional flow reserve derived from cCTA datasets (FFR) and that of cCTA+static stress-computed tomography perfusion (stress-CTP) in detecting functionally significant coronary artery lesions using invasive coronary angiography (ICA) plus invasive FFR as the reference standard.
FFR and static stress-CTP are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using cCTA.
A total of 147 consecutive symptomatic patients scheduled for clinically indicated ICA+invasive FFR were evaluated with cCTA, FFR, and stress-CTP.
Vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values, and accuracy rates of cCTA were 99%, 76%, 100%, 61%, 82%, and 95%, 54%, 94%, 63%, 73%, respectively. cCTA+FFR showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 88%, 94%, 95%, 84%, 92%, and 90%, 85%, 92%, 83%, 87%, respectively. Finally, cCTA+stress-CTP showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 92%, 95%, 97%, 87%, 94% and 98%, 87%, 99%, 86%, 92%, respectively. Both FFR and stress-CTP significantly improved specificity and positive predictive values compared to those of cCTA alone. The area under the curve to detect flow-limiting stenoses of cCTA, cCTA+FFR, and cCTA+CTP were 0.89, 0.93, 0.92, and 0.90, 0.94, and 0.93 in a vessel-based and patient-based model, respectively, with significant additional values for both cCTA+FFR and cCTA+CTP versus cCTA alone (p < 0.001) but no differences between cCTA+FFR versus cCTA+CTP.
FFR and stress-CTP in addition to cCTA are valid and comparable tools to evaluate the functional relevance of CAD.
本研究旨在比较冠状动脉计算机断层血管造影术（cCTA）与 cCTA 联合衍生的血流储备分数（FFR）和 cCTA 联合静息状态计算机断层灌注（stress-CTP）检测冠状动脉功能意义狭窄的诊断准确性，以有创冠状动脉造影术（ICA）加有创血流储备分数（FFR）为参考标准。
FFR 和静息状态 stress-CTP 是结合解剖学和功能评估的新技术，用于提高 cCTA 评估冠状动脉疾病（CAD）的能力。
对 147 例因有症状而拟行临床有创 ICA+有创 FFR 的连续患者进行 cCTA、FFR 和 stress-CTP 评估。
基于血管和基于患者的 cCTA 敏感性、特异性、阴性预测值、阳性预测值和准确率分别为 99%、76%、100%、61%、82%和 95%，54%、94%、63%、73%、分别。cCTA+FFR 的基于血管和基于患者的敏感性、特异性、阴性预测值、阳性预测值和准确率分别为 88%、94%、95%、84%、92%和 90%、85%、92%、83%、87%。最后，cCTA+stress-CTP 的基于血管和基于患者的敏感性、特异性、阴性预测值、阳性预测值和准确率分别为 92%、95%、97%、87%、94%和 98%、87%、99%、86%、92%。FFR 和 stress-CTP 均显著提高了 cCTA 单独检测时的特异性和阳性预测值。cCTA、cCTA+FFR 和 cCTA+CTP 检测血流限制狭窄的曲线下面积分别为 0.89、0.93、0.92 和 0.90、0.94 和 0.93，基于血管和基于患者的模型均具有显著的附加价值，cCTA+FFR 和 cCTA+CTP 均优于 cCTA 单独检测（p<0.001），但 cCTA+FFR 与 cCTA+CTP 之间无差异。
FFR 和 stress-CTP 联合 cCTA 是评估 CAD 功能相关性的有效且可比的工具。
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