+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Noninvasive diagnosis of ischemia-causing coronary stenosis using CT angiography: diagnostic value of transluminal attenuation gradient and fractional flow reserve computed from coronary CT angiography compared to invasively measured fractional flow reserve



Noninvasive diagnosis of ischemia-causing coronary stenosis using CT angiography: diagnostic value of transluminal attenuation gradient and fractional flow reserve computed from coronary CT angiography compared to invasively measured fractional flow reserve



Jacc. Cardiovascular Imaging 5(11): 1088-1096



The aim of this study was to compare the diagnostic performance of coronary computed tomography angiography (CCTA)-derived computed fractional flow reserve (FFRCT) and transluminal attenuation gradient (TAG) for the diagnosis of lesion-specific ischemia. Although CCTA is commonly used to detect coronary artery disease (CAD), it cannot reliably assess the functional significance of CAD. Novel technologies based on CCTA were developed to integrate anatomical and functional assessment of CAD; however, the diagnostic performance of these methods has never been compared. Fifty-three consecutive patients who underwent CCTA and coronary angiography with FFR measurement were included. Independent core laboratories determined CAD severity by CCTA, TAG, and FFRCT. The TAG was defined as the linear regression coefficient between intraluminal radiological attenuation and length from the ostium; FFRCT was computed from CCTA data using computational fluid dynamics technology. Among 82 vessels, 32 lesions (39%) had ischemia by invasive FFR (FFR ?0.80). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratio of TAG (? ?0.654 HU/mm) for detection of ischemia were 38%, 88%, 67%, 69%, 3.13, and 0.71, respectively; and those of FFRCT were 81%, 94%, 90%, 89%, 13.54, and 0.20, respectively. Receiver-operating characteristic curve analysis showed a significantly larger area under the curve (AUC) for FFRCT (0.94) compared to that for TAG (0.63, p < 0.001) and CCTA stenosis (0.73, p < 0.001). In vessels with noncalcified plaque or partially calcified plaque, FFRCT showed a larger AUC (0.94) compared to that of TAG (0.63, p < 0.001) or CCTA stenosis (0.70, p < 0.001). In vessels with calcified plaque, AUC of FFRCT (0.92) was not statistically larger than that of TAG (0.75, p = 0.168) or CCTA stenosis (0.80, p = 0.195). Noninvasive FFR computed from CCTA provides better diagnostic performance for the diagnosis of lesion-specific ischemia compared to CCTA stenosis and TAG.

(PDF emailed within 0-6 h: $19.90)

Accession: 054648172

Download citation: RISBibTeXText

PMID: 23153908

DOI: 10.1016/j.jcmg.2012.09.002


Related references

Transluminal attenuation gradient in coronary computed tomography angiography is a novel noninvasive approach to the identification of functionally significant coronary artery stenosis: a comparison with fractional flow reserve. Journal of the American College of Cardiology 61(12): 1271-1279, 2013

Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in ischemia-causing coronary stenosis: a meta-analysis. Japanese Journal of Radiology 34(12): 795-808, 2016

Diagnostic performance of transluminal attenuation gradient and fractional flow reserve by coronary computed tomographic angiography (FFR(CT)) compared to invasive FFR: a sub-group analysis from the DISCOVER-FLOW and DeFACTO studies. International Journal of Cardiovascular Imaging 31(6): 1251-1259, 2016

Diagnostic Performance of Transluminal Attenuation Gradient and Noninvasive Fractional Flow Reserve Derived from 320-Detector Row CT Angiography to Diagnose Hemodynamically Significant Coronary Stenosis: An NXT Substudy. Radiology 279(1): 75-83, 2016

Diagnostic performance of transluminal attenuation gradient and non-invasive fractional flow reserve derived from 320 detector computed tomography angiography to diagnose haemodynamically significant coronary stenosis- a NXT substudy. Heart Lung & Circulation 24: S334-S335, 2015

Accuracy and usefulness of noninvasive fractional flow reserve from computed tomographic coronary angiography: comparison with myocardial perfusion imaging, echocardiographic coronary flow reserve, and invasive fractional flow reserve. Cardiovascular Intervention and Therapeutics 32(1): 66-71, 2015

Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. Journal of the American College of Cardiology 58(19): 1989-1997, 2011

Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). Journal of the American College of Cardiology 63(12): 1145-1155, 2014

Comparison of diagnostic value of a novel noninvasive coronary computed tomography angiography method versus standard coronary angiography for assessing fractional flow reserve. American Journal of Cardiology 114(9): 1303-1308, 2014

Meta-Analysis of Diagnostic Performance of Coronary Computed Tomography Angiography, Computed Tomography Perfusion, and Computed Tomography-Fractional Flow Reserve in Functional Myocardial Ischemia Assessment Versus Invasive Fractional Flow Reserve. American Journal of Cardiology 116(9): 1469-1478, 2016

Noninvasive Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography for the Diagnosis of Lesion-specific Ischemia. Interventional Cardiology Clinics 4(4): 481-489, 2015

Comparison of diagnostic accuracy of combined assessment using adenosine stress computed tomography perfusion + computed tomography angiography with transluminal attenuation gradient + computed tomography angiography against invasive fractional flow reserve. Journal of the American College of Cardiology 63(18): 1904-1912, 2014

Diagnostic accuracy and discrimination of ischemia by fractional flow reserve CT using a clinical use rule: results from the Determination of Fractional Flow Reserve by Anatomic Computed Tomographic Angiography study. Journal of Cardiovascular Computed Tomography 9(2): 120-128, 2015

Hemodynamic impact of coronary stenosis using computed tomography: comparison between noninvasive fractional flow reserve and 3D fusion of coronary angiography with stress myocardial perfusion. International Journal of Cardiovascular Imaging 2019, 2019

Diagnostic value of quantitative stenosis predictors with coronary CT angiography compared to invasive fractional flow reserve. European Journal of Radiology 84(8): 1509-1515, 2016