Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography.

Dahl, Jonathan N; Rasmussen, Laust D; Ding, Daixin; Tu, Shengxian; Westra, Jelmer; Wijns, William; Christiansen, Evald Høj; Eftekhari, Ashkan; Li, Guanyu; Winther, Simon; Bøttcher, Morten

Dahl, Jonathan N; Rasmussen, Laust D; Ding, Daixin; Tu, Shengxian; Westra, Jelmer; Wijns, William; Christiansen, Evald Høj; Eftekhari, Ashkan; Li, Guanyu; Winther, Simon; Bøttcher, Morten.

Afiliação

Dahl JN; Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: jonadh@rm.dk.
Rasmussen LD; Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. Electronic address: laust.dupont@midt.rm.dk.
Ding D; The Lambe Institute for Translational Research and Curam, University of Galway, Ireland; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China. Electronic address: d.ding2@nuigalway.ie.
Tu S; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China; Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China. Electronic address: sxtu@sjtu.edu.cn.
Westra J; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Denmark. Electronic address: jelwes@rm.dk.
Wijns W; The Lambe Institute for Translational Research and Curam, University of Galway, Ireland. Electronic address: william.wyns@nuigalway.ie.
Christiansen EH; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Denmark. Electronic address: evald.christiansen@rm.dk.
Eftekhari A; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. Electronic address: asef@rn.dk.
Li G; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China. Electronic address: guanyu.li@sjtu.edu.cn.
Winther S; Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: sw@dadlnet.dk.
Bøttcher M; Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: morboett@rm.dk.

J Cardiovasc Comput Tomogr ; 18(2): 162-169, 2024.

Article em En | MEDLINE | ID: mdl-38242777

ABSTRACT

ABSTRACT

BACKGROUND:

Coronary computed tomography angiography (CCTA)-derived quantitative flow ratio (CT-QFR) is an on-site non-invasive technique estimating invasive fractional flow reserve (FFR). This study assesses the diagnostic performance of using most distal CT-QFR versus lesion-specific CT-QFR approach for identifying hemodynamically obstructive coronary artery disease (CAD).

METHODS:

Prospectively enrolled de novo chest pain patients (n â= â445) with ≥50 â% visual diameter stenosis on CCTA were referred for invasive evaluation. On-site CT-QFR was analyzed post-hoc blinded to angiographic data and obtained as both most distal (MD-QFR) and lesion-specific CT-QFR (LS-QFR). Abnormal CT-QFR was defined as ≤0.80. Hemodynamically obstructive CAD was defined as invasive FFR ≤0.80 or ≥70 â% diameter stenosis by 3D-quantitative coronary angiography.

RESULTS:

In total 404/445 patients had paired CT-QFR and invasive analyses of whom 149/404 (37 â%) had hemodynamically obstructive CAD. MD-QFR and LS-QFR classified 188 (47 â%) and 165 (41 â%) patients as abnormal, respectively. Areas under the receiver-operating characteristic curve for MD-QFR was 0.83 vs. 0.85 for LS-QFR, p â= â0.01. Sensitivities for MD-QFR and LS-QFR were 80 â% (95%CI 73-86) vs. 77 â% (95%CI 69-83), p â= â0.03, respectively, and specificities were 73 â% (95%CI 67-78) vs. 80 â% (95%CI 75-85), p â< â0.01, respectively. Positive predictive values for MD-QFR and LS-QFR were 63 â% vs. 69 â%, p â< â0.01, respectively, and negative predictive values for MD-QFR and LS-QFR were 86 â% vs. 85 â%, p â= â0.39, respectively).

CONCLUSION:

Using a lesion-specific CT-QFR approach has superior discrimination of hemodynamically obstructive CAD compared to a most distal CT-QFR approach. CT-QFR identified most cases of hemodynamically obstructive CAD while a normal CT-QFR excluded hemodynamically obstructive CAD in the majority of patients.

Assuntos

Doença da Artéria Coronariana; Estenose Coronária; Reserva Fracionada de Fluxo Miocárdico; Humanos; Angiografia por Tomografia Computadorizada/métodos; Constrição Patológica; Valor Preditivo dos Testes; Doença da Artéria Coronariana/diagnóstico por imagem; Tomografia Computadorizada por Raios X; Angiografia Coronária/métodos

Palavras-chave

Computed tomography derived quantitative flow reserve; Coronary artery disease; Coronary computed tomography angiography; Fractional flow reserve; Non-invasive cardiac imaging; Quantitative coronary analysis

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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Estenose Coronária / Reserva Fracionada de Fluxo Miocárdico Tipo de estudo: Diagnostic_studies / Prognostic_studies Limite: Humans Idioma: En Revista: J Cardiovasc Comput Tomogr Assunto da revista: ANGIOLOGIA / CARDIOLOGIA / RADIOLOGIA Ano de publicação: 2024 Tipo de documento: Article

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