Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Sci Rep. 2021 Mar 24;11(1):6748. doi: 10.1038/s41598-021-86245-8.
Multiple non-invasive tests are performed to diagnose coronary artery disease (CAD), but all are limited to either anatomical or functional assessments. Computed tomography derived Fractional Flow Reserve (CT-FFR) based on patient-specific lumped parameter models is a new test combining both characteristics simulating invasive FFR. This study aims to evaluate the added value of CT-FFR over other non-invasive tests to diagnose CAD. Patients with clinical suspicion of angina pectoris between 2010 and 2011 were included in this cross-sectional study. All underwent stress electrocardiography (X-ECG), SPECT, CT coronary angiography (CCTA) and CT-FFR. Invasive coronary angiography (ICA) and FFR were used as reference standard. Five models mimicking the clinical workflow were fitted and the area under receiver operating characteristic (AUROC) curve was used for comparison. 44% of the patients included in the analysis had a FFR of ≤ 0.80. The basic model including pre-test-likelihood and X-ECG had an AUROC of 0.79. The SPECT-strategy had an AUROC of 0.90 (p = 0.008), CCTA-strategy of 0.88 (p < 0.001), 0.93 when adding CT-FFR (p = 0.40) compared to 0.94 when combining CCTA and SPECT. This study shows adding on-site CT-FFR based on patient-specific lumped parameter models leads to an increased AUROC compared to the basic model. It improves the diagnostic work-up beyond SPECT or CCTA and is non-inferior to the combined strategy of SPECT and CCTA in the diagnosis of hemodynamically relevant CAD.
多种非侵入性检查用于诊断冠状动脉疾病（CAD），但都仅限于解剖或功能评估。基于患者特定集总参数模型的计算机断层扫描衍生的血流储备分数（CT-FFR）是一种新的测试方法，结合了模拟有创 FFR 的这两种特性。本研究旨在评估 CT-FFR 在诊断 CAD 方面相对于其他非侵入性检查的附加价值。2010 年至 2011 年期间，有临床心绞痛怀疑的患者被纳入本横断面研究。所有患者均接受了负荷心电图（X-ECG）、单光子发射计算机断层扫描（SPECT）、CT 冠状动脉造影（CCTA）和 CT-FFR 检查。采用有创冠状动脉造影（ICA）和 FFR 作为参考标准。拟合了 5 种模拟临床工作流程的模型，并使用接受者操作特征（ROC）曲线下面积（AUROC）进行比较。分析中纳入的患者中有 44%的患者 FFR 值≤0.80。包括预测试可能性和 X-ECG 的基本模型的 AUROC 为 0.79。SPECT 策略的 AUROC 为 0.90（p=0.008），CCTA 策略的 AUROC 为 0.88（p<0.001），当添加 CT-FFR 时为 0.93（p=0.40），当结合 CCTA 和 SPECT 时为 0.94。本研究表明，基于患者特定集总参数模型的现场 CT-FFR 可提高 AUROC 与基本模型相比。它改善了诊断工作流程，超越了 SPECT 或 CCTA，在诊断与血流动力学相关的 CAD 方面，与 SPECT 和 CCTA 的联合策略无差异。
