Coronary Artery Stenosis Evaluation by Angiography-Derived FFR: Validation by Positron Emission Tomography and Invasive Thermodilution.
JACC Cardiovasc Imaging
; 16(10): 1321-1331, 2023 10.
Article
em En
| MEDLINE
| ID: mdl-37052562
ABSTRACT
BACKGROUND:
Fractional flow reserve (FFR) derived from invasive coronary angiography (QFR) is promising for evaluation of intermediate coronary artery stenosis.OBJECTIVES:
The authors aimed to compare the diagnostic performance of QFR and the guideline-recommended invasive FFR using 82Rubidium positron emission tomography (82Rb-PET) myocardial perfusion imaging as reference standard.METHODS:
This is a prospective, observational study of symptomatic patients with suspected obstructive coronary artery disease on coronary computed tomography angiography (≥50% diameter stenosis in ≥1 vessel). All patients were referred to 82Rb-PET and invasive coronary angiography with FFR and QFR assessment of all intermediate (30%-90% diameter stenosis) stenoses. Main analyses included a comparison of the ability of QFR and FFR to identify reduced myocardial blood flow (<2 mL/g/min) during vasodilation and/or relative perfusion abnormalities (summed stress score ≥4 in ≥2 adjacent segments).RESULTS:
A total of 250 patients (320 vessels) with indication for invasive physiological assessment were included. The continuous relationship of 82Rb-PET stress myocardial blood flow per 0.10 increase in FFR was +0.14 mL/g/min (95% CI 0.07-0.21 mL/g/min) and +0.08 mL/g/min (95% CI 0.02-0.14 mL/g/min) per 0.10 QFR increase. Using 82Rb-PET as reference, QFR and FFR had similar diagnostic performance on both a per-patient level (accuracy 73%; 95% CI 67%-79%; vs accuracy 71%; 95% CI 64%-78%) and per-vessel level (accuracy 70%; 95% CI 64%-75%; vs accuracy 68%; 95% CI 62%-73%). The per-vessel feasibility was 84% (95% CI 80%-88%) for QFR and 88% (95% CI 85%-92%) for FFR by intention-to-diagnose analysis.CONCLUSIONS:
With 82Rb-PET as reference modality, the wire-free QFR solution showed similar diagnostic accuracy as invasive FFR in evaluation of intermediate coronary stenosis. (DAN-NICAD - Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease; NCT02264717).Palavras-chave
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:
Guideline
/
Observational_studies
/
Prognostic_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article