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Influence of Coronary Calcification on the Diagnostic Performance of CT Angiography Derived FFR in Coronary Artery Disease: A Substudy of the NXT Trial.
JACC Cardiovasc Imaging. 2015 Sep; 8(9):1045-1055.JC

Abstract

OBJECTIVES

The goal of this study was to examine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) in relation to coronary calcification severity.

BACKGROUND

FFRCT has shown promising results in identifying lesion-specific ischemia. The extent to which the severity of coronary calcification affects the diagnostic performance of FFRCT is not known.

METHODS

Coronary calcification was assessed by using the Agatston score (AS) in 214 patients suspected of having coronary artery disease who underwent coronary CTA, FFRCT, and FFR (FFR examination was performed in 333 vessels). The diagnostic performance of FFRCT (≤0.80) in identifying vessel-specific ischemia (FFR ≤0.80) was investigated across AS quartiles (Q1 to Q4) and for discrimination of ischemia in patients and vessels with a low-mid AS (Q1 to Q3) versus a high AS (Q4). Coronary CTA stenosis was defined as lumen reduction >50%.

RESULTS

Mean ± SD per-patient and per-vessel AS were 302 ± 468 (range 0 to 3,599) and 95 ± 172 (range 0 to 1,703), respectively. There was no statistical difference in diagnostic accuracy, sensitivity, or specificity of FFRCT across AS quartiles. Discrimination of ischemia by FFRCT was high in patients with a high AS (416 to 3,599) and a low-mid AS (0 to 415), with no difference in area under the receiver-operating characteristic curve (AUC) (0.86 [95% confidence interval (CI): 0.76 to 0.96] vs. 0.92 [95% CI: 0.88 to 0.96]) (p = 0.45). Similarly, discrimination of ischemia by FFRCT was high in vessels with a high AS (121 to 1,703) and a low-mid AS (0 to 120) (AUC: 0.91 [95% CI: 0.85 to 0.97] vs. 0.95 [95% CI: 0.91 to 0.98]; p = 0.65). Diagnostic accuracy and specificity of FFRCT were significantly higher than for stenosis assessment in each AS quartile at the per-patient (p < 0.001) and per-vessel (p < 0.05) level with similar sensitivity. In vessels with a high AS, FFRCT exhibited improved discrimination of ischemia compared with coronary CTA alone (AUC: 0.91 vs. 0.71; p = 0.004), whereas on a per-patient level, the difference did not reach statistical significance (AUC: 0.86 vs. 0.72; p = 0.09).

CONCLUSIONS

FFRCT provided high and superior diagnostic performance compared with coronary CTA interpretation alone in patients and vessels with a high AS.

Authors+Show Affiliations

Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. Electronic address: bnorgaard@dadlnet.dk.Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.Department of Cardiology, Okayama University Hospital, Okayama, Japan.Department of Cardiology, Okayama University Hospital, Okayama, Japan.Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.Diagnostic Institute of Radiology, Paul Stradins Clinical University Hospital, Riga, Latvia.Department of Radiology, Golden Jubilee Hospital, Glasgow, Scotland.Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.MonashHeart, Monash Medical Center and Monash University, Victoria, Australia.Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio.Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.Department of Cardiology, Erlangen University Hospital, Erlangen, Germany.

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

26298072

Citation

Nørgaard, Bjarne L., et al. "Influence of Coronary Calcification On the Diagnostic Performance of CT Angiography Derived FFR in Coronary Artery Disease: a Substudy of the NXT Trial." JACC. Cardiovascular Imaging, vol. 8, no. 9, 2015, pp. 1045-1055.
Nørgaard BL, Gaur S, Leipsic J, et al. Influence of Coronary Calcification on the Diagnostic Performance of CT Angiography Derived FFR in Coronary Artery Disease: A Substudy of the NXT Trial. JACC Cardiovasc Imaging. 2015;8(9):1045-1055.
Nørgaard, B. L., Gaur, S., Leipsic, J., Ito, H., Miyoshi, T., Park, S. J., Zvaigzne, L., Tzemos, N., Jensen, J. M., Hansson, N., Ko, B., Bezerra, H., Christiansen, E. H., Kaltoft, A., Lassen, J. F., Bøtker, H. E., & Achenbach, S. (2015). Influence of Coronary Calcification on the Diagnostic Performance of CT Angiography Derived FFR in Coronary Artery Disease: A Substudy of the NXT Trial. JACC. Cardiovascular Imaging, 8(9), 1045-1055. https://doi.org/10.1016/j.jcmg.2015.06.003
Nørgaard BL, et al. Influence of Coronary Calcification On the Diagnostic Performance of CT Angiography Derived FFR in Coronary Artery Disease: a Substudy of the NXT Trial. JACC Cardiovasc Imaging. 2015;8(9):1045-1055. PubMed PMID: 26298072.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of Coronary Calcification on the Diagnostic Performance of CT Angiography Derived FFR in Coronary Artery Disease: A Substudy of the NXT Trial. AU - Nørgaard,Bjarne L, AU - Gaur,Sara, AU - Leipsic,Jonathon, AU - Ito,Hiroshi, AU - Miyoshi,Toru, AU - Park,Seung-Jung, AU - Zvaigzne,Ligita, AU - Tzemos,Nikolaos, AU - Jensen,Jesper M, AU - Hansson,Nicolaj, AU - Ko,Brian, AU - Bezerra,Hiram, AU - Christiansen,Evald H, AU - Kaltoft,Anne, AU - Lassen,Jens F, AU - Bøtker,Hans Erik, AU - Achenbach,Stephan, Y1 - 2015/08/19/ PY - 2015/04/14/received PY - 2015/05/26/revised PY - 2015/06/04/accepted PY - 2015/8/24/entrez PY - 2015/8/25/pubmed PY - 2016/6/30/medline KW - computed tomography angiography KW - coronary angiography KW - coronary artery disease KW - coronary calcification KW - fractional flow reserve SP - 1045 EP - 1055 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 8 IS - 9 N2 - OBJECTIVES: The goal of this study was to examine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) in relation to coronary calcification severity. BACKGROUND: FFRCT has shown promising results in identifying lesion-specific ischemia. The extent to which the severity of coronary calcification affects the diagnostic performance of FFRCT is not known. METHODS: Coronary calcification was assessed by using the Agatston score (AS) in 214 patients suspected of having coronary artery disease who underwent coronary CTA, FFRCT, and FFR (FFR examination was performed in 333 vessels). The diagnostic performance of FFRCT (≤0.80) in identifying vessel-specific ischemia (FFR ≤0.80) was investigated across AS quartiles (Q1 to Q4) and for discrimination of ischemia in patients and vessels with a low-mid AS (Q1 to Q3) versus a high AS (Q4). Coronary CTA stenosis was defined as lumen reduction >50%. RESULTS: Mean ± SD per-patient and per-vessel AS were 302 ± 468 (range 0 to 3,599) and 95 ± 172 (range 0 to 1,703), respectively. There was no statistical difference in diagnostic accuracy, sensitivity, or specificity of FFRCT across AS quartiles. Discrimination of ischemia by FFRCT was high in patients with a high AS (416 to 3,599) and a low-mid AS (0 to 415), with no difference in area under the receiver-operating characteristic curve (AUC) (0.86 [95% confidence interval (CI): 0.76 to 0.96] vs. 0.92 [95% CI: 0.88 to 0.96]) (p = 0.45). Similarly, discrimination of ischemia by FFRCT was high in vessels with a high AS (121 to 1,703) and a low-mid AS (0 to 120) (AUC: 0.91 [95% CI: 0.85 to 0.97] vs. 0.95 [95% CI: 0.91 to 0.98]; p = 0.65). Diagnostic accuracy and specificity of FFRCT were significantly higher than for stenosis assessment in each AS quartile at the per-patient (p < 0.001) and per-vessel (p < 0.05) level with similar sensitivity. In vessels with a high AS, FFRCT exhibited improved discrimination of ischemia compared with coronary CTA alone (AUC: 0.91 vs. 0.71; p = 0.004), whereas on a per-patient level, the difference did not reach statistical significance (AUC: 0.86 vs. 0.72; p = 0.09). CONCLUSIONS: FFRCT provided high and superior diagnostic performance compared with coronary CTA interpretation alone in patients and vessels with a high AS. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/26298072/Influence_of_Coronary_Calcification_on_the_Diagnostic_Performance_of_CT_Angiography_Derived_FFR_in_Coronary_Artery_Disease:_A_Substudy_of_the_NXT_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(15)00420-9 DB - PRIME DP - Unbound Medicine ER -