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Prediction of Coronary Revascularization in Stable Angina: Comparison of FFRCT With CMR Stress Perfusion Imaging.
JACC Cardiovasc Imaging. 2020 04; 13(4):994-1004.JC

Abstract

OBJECTIVES

This study was designed to compare head-to-head fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) and cardiac magnetic resonance (CMR) stress perfusion imaging for prediction of standard-of-care-guided coronary revascularization in patients with stable chest pain and obstructive coronary artery disease by coronary CTA.

BACKGROUND

FFRCT is a novel modality for noninvasive functional testing. The clinical utility of FFRCT compared to CMR stress perfusion imaging in symptomatic patients with coronary artery disease is unknown.

METHODS

Prospective study of patients (n = 110) with stable angina pectoris and 1 or more coronary stenosis ≥50% by coronary CTA. All patients underwent invasive coronary angiography. Revascularization was FFR-guided in stenoses ranging from 30% to 90%. FFRCT ≤0.80 in 1 or more coronary artery or a reversible perfusion defect (≥2 segments) by CMR categorized patients with ischemia. FFRCT and CMR were analyzed by core laboratories blinded for patient management.

RESULTS

A total of 38 patients (35%) underwent revascularization. Per-patient diagnostic performance for identifying standard-of-care-guided revascularization, (95% confidence interval) yielded a sensitivity of 97% (86% to 100%) for FFRCT versus 47% (31% to 64%) for CMR, p < 0.001; corresponding specificity was 42% (30% to 54%) versus 88% (78% to 94%), p < 0.001; negative predictive value of 97% (91% to 100%) versus 76% (67% to 85%), p < 0.05; positive predictive value of 47% (36% to 58%) versus 67% (49% to 84%), p < 0.05; and accuracy of 61% (51% to 70%) versus 74% (64% to 82%), p > 0.05, respectively.

CONCLUSIONS

In patients with stable chest pain referred to invasive coronary angiography based on coronary CTA, FFRCT and CMR yielded similar overall diagnostic accuracy. Sensitivity for prediction of revascularization was highest for FFRCT, whereas specificity was highest for CMR.

Authors+Show Affiliations

Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark. Electronic address: npsand@webspeed.dk.Department of Cardiology, Hospital Unit West Jutland, Herning, Denmark.Department of Cardiology, Hospital Unit West Jutland, Herning, Denmark; Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom.Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.Department of Epidemiology and Biostatistics, University of Southern Denmark, Odense, Denmark.Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark.Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark.Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark.Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark.Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark.Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark.Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.Department of Cardiology, Hospital Unit West Jutland, Herning, Denmark.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31422146

Citation

Rønnow Sand, Niels Peter, et al. "Prediction of Coronary Revascularization in Stable Angina: Comparison of FFRCT With CMR Stress Perfusion Imaging." JACC. Cardiovascular Imaging, vol. 13, no. 4, 2020, pp. 994-1004.
Rønnow Sand NP, Nissen L, Winther S, et al. Prediction of Coronary Revascularization in Stable Angina: Comparison of FFRCT With CMR Stress Perfusion Imaging. JACC Cardiovasc Imaging. 2020;13(4):994-1004.
Rønnow Sand, N. P., Nissen, L., Winther, S., Petersen, S. E., Westra, J., Christiansen, E. H., Larsen, P., Holm, N. R., Isaksen, C., Urbonaviciene, G., Deibjerg, L., Husain, M., Thomsen, K. K., Rohold, A., Bøtker, H. E., & Bøttcher, M. (2020). Prediction of Coronary Revascularization in Stable Angina: Comparison of FFRCT With CMR Stress Perfusion Imaging. JACC. Cardiovascular Imaging, 13(4), 994-1004. https://doi.org/10.1016/j.jcmg.2019.06.028
Rønnow Sand NP, et al. Prediction of Coronary Revascularization in Stable Angina: Comparison of FFRCT With CMR Stress Perfusion Imaging. JACC Cardiovasc Imaging. 2020;13(4):994-1004. PubMed PMID: 31422146.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of Coronary Revascularization in Stable Angina: Comparison of FFRCT With CMR Stress Perfusion Imaging. AU - Rønnow Sand,Niels Peter, AU - Nissen,Louise, AU - Winther,Simon, AU - Petersen,Steffen E, AU - Westra,Jelmer, AU - Christiansen,Evald H, AU - Larsen,Pia, AU - Holm,Niels R, AU - Isaksen,Christin, AU - Urbonaviciene,Grazina, AU - Deibjerg,Lone, AU - Husain,Majed, AU - Thomsen,Kristian K, AU - Rohold,Allan, AU - Bøtker,Hans Erik, AU - Bøttcher,Morten, Y1 - 2019/08/14/ PY - 2019/01/30/received PY - 2019/05/20/revised PY - 2019/06/28/accepted PY - 2019/8/20/pubmed PY - 2021/1/6/medline PY - 2019/8/19/entrez KW - cardiac magnetic resonance stress perfusion imaging KW - coronary computed tomography angiography–derived fractional flow reserve KW - revascularization KW - stable angina SP - 994 EP - 1004 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 13 IS - 4 N2 - OBJECTIVES: This study was designed to compare head-to-head fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) and cardiac magnetic resonance (CMR) stress perfusion imaging for prediction of standard-of-care-guided coronary revascularization in patients with stable chest pain and obstructive coronary artery disease by coronary CTA. BACKGROUND: FFRCT is a novel modality for noninvasive functional testing. The clinical utility of FFRCT compared to CMR stress perfusion imaging in symptomatic patients with coronary artery disease is unknown. METHODS: Prospective study of patients (n = 110) with stable angina pectoris and 1 or more coronary stenosis ≥50% by coronary CTA. All patients underwent invasive coronary angiography. Revascularization was FFR-guided in stenoses ranging from 30% to 90%. FFRCT ≤0.80 in 1 or more coronary artery or a reversible perfusion defect (≥2 segments) by CMR categorized patients with ischemia. FFRCT and CMR were analyzed by core laboratories blinded for patient management. RESULTS: A total of 38 patients (35%) underwent revascularization. Per-patient diagnostic performance for identifying standard-of-care-guided revascularization, (95% confidence interval) yielded a sensitivity of 97% (86% to 100%) for FFRCT versus 47% (31% to 64%) for CMR, p < 0.001; corresponding specificity was 42% (30% to 54%) versus 88% (78% to 94%), p < 0.001; negative predictive value of 97% (91% to 100%) versus 76% (67% to 85%), p < 0.05; positive predictive value of 47% (36% to 58%) versus 67% (49% to 84%), p < 0.05; and accuracy of 61% (51% to 70%) versus 74% (64% to 82%), p > 0.05, respectively. CONCLUSIONS: In patients with stable chest pain referred to invasive coronary angiography based on coronary CTA, FFRCT and CMR yielded similar overall diagnostic accuracy. Sensitivity for prediction of revascularization was highest for FFRCT, whereas specificity was highest for CMR. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/31422146/Prediction_of_Coronary_Revascularization_in_Stable_Angina:_Comparison_of_FFRCT_With_CMR_Stress_Perfusion_Imaging. L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(19)30636-9 DB - PRIME DP - Unbound Medicine ER -