Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease The PERFECTION Study

JACC-CARDIOVASCULAR IMAGING

卷:12

Article

Pontone, Gianluca¹  Baggiano, Andrea¹  Andreini, Daniele^1,2  Guaricci, Andrea, I^3,4  Guglielmo, Marco¹  Muscogiuri, Giuseppe¹  Fusini, Laura¹  Fazzari, Fabio⁵  Mushtaq, Saima¹  Conte, Edoardo¹  Calligaris, Giuseppe¹  De Martini, Stefano¹  Ferrari, Cristina¹  Galli, Stefano¹  Grancini, Luca¹  Ravagnani, Paolo¹  Teruzzi, Giovanni¹  Trabattoni, Daniela¹  Fabbiocchi, Franco¹  Lualdi, Alessandro^1,2  Montorsi, Piero^1,2  Rabbat, Mark G.^6,7  Bartorelli, Antonio L.^1,8  Pepi, Mauro¹ 

[1] IRCCS, Ctr Cardiol Monzino, Via C Parea 4, I-20138 Milan, Italy

[2] Univ Milan, Dept Cardiovasc Sci & Community Hlth, Milan, Italy

[3] Univ Hosp, Inst Cardiovasc Dis, Dept Emergency & Organ Transplantat, Policlin Bari, Bari, Italy

[4] Univ Foggia, Dept Med & Surg Sci, Foggia, Italy

[5] Univ Hosp P Giaccone, Dept Cardiol, Palermo, Italy

[6] Loyola Univ Chicago, Chicago, IL USA

[7] Edward Hines Jr VA Hosp, Hines, IL USA

[8] Univ Milan, Dept Biomed & Clin Sci Luigi Sacco, Milan, Italy

关键词: accuracy;    computed tomography;    coronary artery disease;    fractional flow reserve;    perfusion;   

DOI  :  10.1016/j.jcmg.2018.08.023

来源: Elsevier

【 摘 要 】

OBJECTIVES This study sought to compare the diagnostic accuracy of coronary computed tomography angiography (cCTA) with that of cCTA+fractional flow reserve derived from cCTA datasets (FFRCT) and that of cCTA+static stress-computed tomography perfusion (stress-CTP) in detecting functionally significant coronary artery lesions using invasive coronary angiography (ICA) plus invasive FFR as the reference standard. BACKGROUND FFRCT and static stress-CTP are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using cCTA. METHODS A total of 147 consecutive symptomatic patients scheduled for clinically indicated ICA+invasive FFR were evaluated with cCTA, FFRCT, and stress-CTP. RESULTS Vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values, and accuracy rates of cCTA were 99%, 76%, 100%, 61%, 82%, and 95%, 54%, 94%, 63%, 73%, respectively. cCTA+FFRCT showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 88%, 94%, 95%, 84%, 92%, and 90%, 85%, 92%, 83%, 87%, respectively. Finally, cCTA+stress-CTP showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 92%, 95%, 97%, 87%, 94% and 98%, 87%, 99%, 86%, 92%, respectively. Both FFRCT and stress-CTP significantly improved specificity and positive predictive values compared to those of cCTA alone. The area under the curve to detect flow-limiting stenoses of cCTA, cCTA+FFRCT, and cCTA+CTP were 0.89, 0.93, 0.92, and 0.90, 0.94, and 0.93 in a vessel-based and patient-based model, respectively, with significant additional values for both cCTA+FFRCT and cCTA+CTP versus cCTA alone (p < 0.001) but no differences between cCTA+FFRCT versus cCTA+CTP. CONCLUSIONS FFRCT and stress-CTP in addition to cCTA are valid and comparable tools to evaluate the functional relevance of CAD. (C) 2019 by the American College of Cardiology Foundation.

【 授权许可】

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