Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved..
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 = 445) with ≥50 % 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 % 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 %) had hemodynamically obstructive CAD. MD-QFR and LS-QFR classified 188 (47 %) and 165 (41 %) patients as abnormal, respectively. Areas under the receiver-operating characteristic curve for MD-QFR was 0.83 vs. 0.85 for LS-QFR, p = 0.01. Sensitivities for MD-QFR and LS-QFR were 80 % (95%CI: 73-86) vs. 77 % (95%CI: 69-83), p = 0.03, respectively, and specificities were 73 % (95%CI: 67-78) vs. 80 % (95%CI: 75-85), p < 0.01, respectively. Positive predictive values for MD-QFR and LS-QFR were 63 % vs. 69 %, p < 0.01, respectively, and negative predictive values for MD-QFR and LS-QFR were 86 % vs. 85 %, p = 0.39, 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:18 |
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| Enthalten in: |
Journal of cardiovascular computed tomography - 18(2024), 2 vom: 08. März, Seite 162-169 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Dahl, Jonathan N [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 11.03.2024 Date Revised 11.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jcct.2024.01.004 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367332728 |
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| 245 | 1 | 0 | |a Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a 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) | ||
| 520 | |a METHODS: Prospectively enrolled de novo chest pain patients (n = 445) with ≥50 % 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 % diameter stenosis by 3D-quantitative coronary angiography | ||
| 520 | |a RESULTS: In total 404/445 patients had paired CT-QFR and invasive analyses of whom 149/404 (37 %) had hemodynamically obstructive CAD. MD-QFR and LS-QFR classified 188 (47 %) and 165 (41 %) patients as abnormal, respectively. Areas under the receiver-operating characteristic curve for MD-QFR was 0.83 vs. 0.85 for LS-QFR, p = 0.01. Sensitivities for MD-QFR and LS-QFR were 80 % (95%CI: 73-86) vs. 77 % (95%CI: 69-83), p = 0.03, respectively, and specificities were 73 % (95%CI: 67-78) vs. 80 % (95%CI: 75-85), p < 0.01, respectively. Positive predictive values for MD-QFR and LS-QFR were 63 % vs. 69 %, p < 0.01, respectively, and negative predictive values for MD-QFR and LS-QFR were 86 % vs. 85 %, p = 0.39, respectively) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Computed tomography derived quantitative flow reserve | |
| 650 | 4 | |a Coronary artery disease | |
| 650 | 4 | |a Coronary computed tomography angiography | |
| 650 | 4 | |a Fractional flow reserve | |
| 650 | 4 | |a Non-invasive cardiac imaging | |
| 650 | 4 | |a Quantitative coronary analysis | |
| 700 | 1 | |a Rasmussen, Laust D |e verfasserin |4 aut | |
| 700 | 1 | |a Ding, Daixin |e verfasserin |4 aut | |
| 700 | 1 | |a Tu, Shengxian |e verfasserin |4 aut | |
| 700 | 1 | |a Westra, Jelmer |e verfasserin |4 aut | |
| 700 | 1 | |a Wijns, William |e verfasserin |4 aut | |
| 700 | 1 | |a Christiansen, Evald Høj |e verfasserin |4 aut | |
| 700 | 1 | |a Eftekhari, Ashkan |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Guanyu |e verfasserin |4 aut | |
| 700 | 1 | |a Winther, Simon |e verfasserin |4 aut | |
| 700 | 1 | |a Bøttcher, Morten |e verfasserin |4 aut | |
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