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Diagnostic performance of on-site CT-derived fractional flow reserve versus CT perfusion

2016; Oxford University Press; Volume: 18; Issue: 4 Linguagem: Inglês

10.1093/ehjci/jew094

2047-2412

Dong Hyun Yang, Young‐Hak Kim, Jae‐Hyung Roh, Joon‐Won Kang, Jung‐Min Ahn, Jihoon Kweon, Jung Bok Lee, Seong Hoon Choi, Eun‐Seok Shin, Duk‐Woo Park, Soo‐Jin Kang, Seung‐Whan Lee, Cheol Whan Lee, Seong‐Wook Park, Seung‐Jung Park, Tae‐Hwan Lim,

Acute Myocardial Infarction Research

To compare the diagnostic accuracy of on-site computed tomography (CT)-derived fractional flow reserve (FFR) and stress CT myocardial perfusion (CTP) in patients with coronary artery disease. Using a prospective CTP registry, 72 patients with invasive FFR were enrolled. CT-derived FFR was computed on-site using rest-phase CTP data. The diagnostic accuracies of coronary CT angiography (CCTA), CT-derived FFR, and stress CTP were evaluated using an area under the receiver-operating characteristic curve (AUC) with invasive FFR as a reference standard. Logistic regression and the net reclassification index (NRI) were used to evaluate incremental differences in CT-derived FFR or CTP compared with CCTA alone. The per-vessel prevalence of haemodynamically significant stenosis (FFR ≤ 0.80) was 39% (54/138). Per-vessel sensitivity and specificity were 94 and 66% for CCTA, 87 and 77% for CT-derived FFR, and 79 and 91% for CTP, respectively. There was no significant difference in the AUC values of CT-derived FFR and CTP (P = 0.845). The diagnostic performance of CCTA (AUC = 0.856) was improved by combining it with CT-derived FFR (AUC = 0.919, P = 0.004, NRI = 1.01) or CTP (AUC = 0.913, P = 0.004, NRI = 0.66). CT-derived FFR values had a moderate correlation with invasive FFR (r = 0.671, P < 0.001). On-site CT-derived FFR combined with CCTA provides an incremental diagnostic improvement over CCTA alone in identifying haemodynamically significant stenosis defined by invasive FFR, with a diagnostic accuracy comparable with CTP.