Comparison of coronary CT angiography-based and invasive coronary angiography-based quantitative flow ratio for functional assessment of coronary stenosis: A multicenter retrospective analysis.

Li, Zehang; Li, Guanyu; Chen, Liudan; Ding, Daixin; Chen, Yankai; Zhang, Jiayin; Xu, Lei; Kubo, Takashi; Zhang, Su; Wang, Yining; Zhou, Xuhui; Tu, Shengxian

Li, Zehang; Li, Guanyu; Chen, Liudan; Ding, Daixin; Chen, Yankai; Zhang, Jiayin; Xu, Lei; Kubo, Takashi; Zhang, Su; Wang, Yining; Zhou, Xuhui; Tu, Shengxian.

Afiliación

Li Z; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China.
Li G; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China.
Chen L; Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
Ding D; The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland.
Chen Y; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China.
Zhang J; Department of Radiology, Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai, China.
Xu L; Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Kubo T; Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Zhang S; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China.
Wang Y; Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: wangyining@pumch.cn.
Zhou X; Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China. Electronic address: zhouxuh@mail.sysu.edu.cn.
Tu S; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China. Electronic address: sxtu@sjtu.edu.cn.

J Cardiovasc Comput Tomogr ; 16(6): 509-516, 2022.

Article en En | MEDLINE | ID: mdl-35811245

ABSTRACT

ABSTRACT

BACKGROUND:

The aim of this study was to evaluate the diagnostic performance of coronary CT angiography (CTA)-based quantitative flow ratio (QFR), namely CT-QFR, and compare it with invasive coronary angiography (ICA)-based Murray law QFR (µQFR), using fractional flow reserve (FFR) as the reference standard.

METHODS:

Patients who underwent coronary CTA, ICA and pressure wire-based FFR assessment within two months were retrospectively analyzed. CT-QFR and µQFR were computed in blinded fashion and compared with FFR, all applying the same cut-off value of ≤0.80 to identify hemodynamically significant stenosis.

RESULTS:

Paired comparison between CT-QFR and µQFR was performed in 191 vessels from 167 patients. Average FFR was 0.81 â± â0.10 and 42.4% vessels had an FFR ≤0.80. CT-QFR had a slightly lower correlation with FFR compared with µQFR, although statistically non-significant (r â= â0.87 versus 0.90, p â= â0.110). The vessel-level diagnostic performance of CT-QFR was slightly lower but without statistical significance than µQFR (AUC â= â0.94 versus 0.97, difference -0.03 [95%CI -0.00-0.06], p â= â0.095), and substantially higher than diameter stenosis by CTA (AUC difference 0.17 [95%CI -0.10-0.23], p â< â0.001). The patient-level diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio for CT-QFR to identify FFR value â≤ â0.80 was 88%, 90%, 86%, 86%, 91%, 6.59 and 0.12, respectively. The diagnostic accuracy of CT-QFR was 84% in extensively calcified lesions, while in vessels with no or less calcification, CT-QFR showed a comparable diagnostic accuracy with µQFR (91% versus 92%, p â= â0.595). Intra- and inter-observer variability in CT-QFR analysis was -0.00 â± â0.04 and 0.00 â± â0.04, respectively.

CONCLUSIONS:

Performance in diagnosis of hemodynamically significant coronary stenosis by CT-QFR was slightly lower but without statistical significance than µQFR, and substantially higher than CTA-derived diameter stenosis. Extensively calcified lesions reduced the diagnostic accuracy of CT-QFR.

Asunto(s)

Enfermedad de la Arteria Coronaria; Estenosis Coronaria; Reserva del Flujo Fraccional Miocárdico; Humanos; Angiografía por Tomografía Computarizada; Angiografía Coronaria; Estudios Retrospectivos; Constricción Patológica; Valor Predictivo de las Pruebas; Vasos Coronarios/diagnóstico por imagen; Índice de Severidad de la Enfermedad

Palabras clave

CTA-Derived quantitative flow ratio (CT-QFR); Coronary CT angiography (CTA); Coronary artery disease (CAD); Coronary physiology; Fractional flow reserve (FFR); Quantitative flow ratio (QFR)

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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Estenosis Coronaria / Reserva del Flujo Fraccional Miocárdico Tipo de estudio: Risk_factors_studies Límite: Humans Idioma: En Revista: J Cardiovasc Comput Tomogr Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA / RADIOLOGIA Año: 2022 Tipo del documento: Article País de afiliación: China

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