Elsevier

The American Journal of Cardiology

Volume 159, 15 November 2021, Pages 36-43
The American Journal of Cardiology

Comparison of Diagnostic Performance of Fractional Flow Reserve Derived from Coronary Computed Tomographic Angiography Versus Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging

https://doi.org/10.1016/j.amjcard.2021.08.012Get rights and content

Fraction flow reserve (FFR) derived from computed tomography (FFRCT) has been proposed to be an effective gatekeeper for invasive angiographic referral. The purpose of the present study is to examine the real-world diagnostic performance of FFRCT and myocardial perfusion imaging as well as to assess the utility of FFRCT as a gatekeeper for invasive coronary angiography in patients suspected of having obstructive coronary artery disease. Total of 146 consecutive patients underwent both single-photon emission computed tomography (SPECT) and invasive FFR were evaluated. An FFRCT value 1 to 2 cm distal to a stenosis ≤0.80 was defined as positive for ischemia and a summed stress score ≥2 or transient ischemic dilatation ≥1.2 were positive for ischemia with the invasive FFR value of <0.80 serving as the gold standard. The patient-based sensitivity of FFRCT was significantly higher than SPECT (91 vs 52%, p <0.001) and exhibited similar positive predictive value (82 vs 82%, p = 0.91). These trends were observed even in patients with multivessel and left main trunk disease and those with severe coronary calcification. In conclusion, our data suggest that FFRCT has higher diagnostic performance characteristics than SPECT and details the superior FFRCT analysis in detecting patients with hemodynamically significant coronary artery disease. Our results support the clinical utility of FFRCT analysis as a gatekeeper for invasive coronary angiography in clinical practice.

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Methods

The present study was ta single-center, retrospective analysis of 1,075 patients with stable angina pectoris or suspected of CAD who showed obstructed CAD >50% by CCTA between July 2015 and October 2018, 437 patients had been enrolled in the ADVANCE Registry.9,10 Of those, a total 146 patients who underwent SPECT MPI and invasive FFR testing within 1 month were examined in this study (Figure 1). All physicians leading the invasive FFR testing for this study were blinded to both FFRCT and SPECT

Result

The baseline characteristics of the 146 examined patients are shown in Table 1. Among the entire population, 254 vessels were confirmed as having significant stenosis, including 134 (53%) LAD, 61 (24%) LCx, and 59 (23%) RCA. Regarding a lesion severity, 130 (51%) were considered as intermediate, and 124 (49%) as severe. The median interval between CCTA and ICA being 21 (18 to 24) days.

The distribution of FFRCT values in the examined diseased vessels is shown in Figure 2. Sixty-six percent

Discussion

Our real-world evaluation of the diagnostic performance of FFRCT for detecting the patients with physiologically significant CAD, showed significantly higher diagnostic sensitivity and similar PPV of FFRCT when compared with SPECT MPI for both the entire population and the subgroups with MVD and LMTD and severe calcification. Our data suggest that that FFRCT is a robust clinical tool and can serve as an effective tool to enrich ICA referral.

There are some reports that support our study's

Disclosures

All authors have no conflict of interest to disclose.

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