Comparison of coronary CT angiography-based and invasive coronary angiography-based quantitative flow ratio for functional assessment of coronary stenosis: A multicenter retrospective analysis |
| |
| Institution: | 1. State Key Laboratory of Cardiovascular Disease, Beijing, China;2. Cardiometabolic Medicine Center, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;3. Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;4. National Clinical Research Center for Cardiovascular Diseases, Beijing, China;5. Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China;6. Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;7. Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China;8. The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Ireland;1. Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China;2. National Clinical Research Center for Cardiovascular Diseases, Beijing, China;3. Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China;4. Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China;5. Hospital Clinico San Carlos, Madrid, Spain;6. Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA;7. New York–Presbyterian Hospital/Columbia University Medical Center, New York, NY;8. Cardiovascular Research Foundation, New York, NY;9. National Heart and Lung Institute, Imperial College London, London, United Kingdom;10. The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland;11. Bern University Hospital, Bern, Switzerland;12. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY |
| |
| Abstract: | BackgroundThe aim of this study was to evaluate the diagnostic performance of coronary CT angiography (CTA)-based quantitative flow ratio (QFR), namely CT-QFR, and compare it with invasive coronary angiography (ICA)-based Murray law QFR (μQFR), using fractional flow reserve (FFR) as the reference standard.MethodsPatients who underwent coronary CTA, ICA and pressure wire-based FFR assessment within two months were retrospectively analyzed. CT-QFR and μQFR were computed in blinded fashion and compared with FFR, all applying the same cut-off value of ≤0.80 to identify hemodynamically significant stenosis.ResultsPaired comparison between CT-QFR and μQFR was performed in 191 vessels from 167 patients. Average FFR was 0.81 ?± ?0.10 and 42.4% vessels had an FFR ≤0.80. CT-QFR had a slightly lower correlation with FFR compared with μQFR, although statistically non-significant (r ?= ?0.87 versus 0.90, p ?= ?0.110). The vessel-level diagnostic performance of CT-QFR was slightly lower but without statistical significance than μQFR (AUC ?= ?0.94 versus 0.97, difference: ?0.03 95%CI: ?0.00-0.06], p ?= ?0.095), and substantially higher than diameter stenosis by CTA (AUC difference: 0.17 95%CI: ?0.10-0.23], p ?< ?0.001). The patient-level diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio for CT-QFR to identify FFR value ?≤ ?0.80 was 88%, 90%, 86%, 86%, 91%, 6.59 and 0.12, respectively. The diagnostic accuracy of CT-QFR was 84% in extensively calcified lesions, while in vessels with no or less calcification, CT-QFR showed a comparable diagnostic accuracy with μQFR (91% versus 92%, p ?= ?0.595). Intra- and inter-observer variability in CT-QFR analysis was ?0.00 ?± ?0.04 and 0.00 ?± ?0.04, respectively.ConclusionsPerformance in diagnosis of hemodynamically significant coronary stenosis by CT-QFR was slightly lower but without statistical significance than μQFR, and substantially higher than CTA-derived diameter stenosis. Extensively calcified lesions reduced the diagnostic accuracy of CT-QFR. |
| |
| Keywords: | Coronary artery disease (CAD) Fractional flow reserve (FFR) Coronary CT angiography (CTA) Coronary physiology Quantitative flow ratio (QFR) CTA-Derived quantitative flow ratio (CT-QFR) CABG"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"coronary artery bypass grafting CAD"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"coronary artery disease CFD"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"computational fluid dynamics CTA"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"CT angiography CT-QFR"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"CTA-derived quantitative flow ratio DS%"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"percent diameter stenosis FFR"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"fractional flow reserve FFRct"} {"#name":"keyword" "$":{"id":"kwrd0115"} "$$":[{"#name":"text" "_":"CT-derived fractional flow reserve ICA"} {"#name":"keyword" "$":{"id":"kwrd0125"} "$$":[{"#name":"text" "_":"invasive coronary angiography LAD"} {"#name":"keyword" "$":{"id":"kwrd0135"} "$$":[{"#name":"text" "_":"left anterior descending artery PCI"} {"#name":"keyword" "$":{"id":"kwrd0145"} "$$":[{"#name":"text" "_":"percutaneous coronary intervention QFR"} {"#name":"keyword" "$":{"id":"kwrd0155"} "$$":[{"#name":"text" "_":"quantitative flow ratio μQFR"} {"#name":"keyword" "$":{"id":"kwrd0165"} "$$":[{"#name":"text" "_":"invasive coronary angiography-based Murray law QFR |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
