dc.contributor.advisor | CC-NC-ND | |
dc.contributor.author | Coenen, A | |
dc.contributor.author | Rossi, A | |
dc.contributor.author | Lubbers, MM | |
dc.contributor.author | Kurata, A | |
dc.contributor.author | Kono, AK | |
dc.contributor.author | Chelu, RG | |
dc.contributor.author | Segreto, S | |
dc.contributor.author | Dijkshoorn, ML | |
dc.contributor.author | Wragg, A | |
dc.contributor.author | van Geuns, R-JM | |
dc.contributor.author | Pugliese, F | |
dc.contributor.author | Nieman, K | |
dc.date.accessioned | 2018-09-09T12:16:51Z | |
dc.date.available | 2018-09-09T12:16:51Z | |
dc.date.issued | 2017-07 | |
dc.date.submitted | 2017-09-28T15:29:28.702Z | |
dc.identifier.citation | Coenen, A., et al. (2017). "Integrating CT Myocardial Perfusion and CT-FFR in the Work-Up of Coronary Artery Disease." JACC: Cardiovascular Imaging 10(7): 760-770. | en_US |
dc.identifier.issn | 1936-878X | |
dc.identifier.other | 10.1016/j.jcmg.2016.09.028 | |
dc.identifier.uri | https://www.sciencedirect.com/science/article/pii/S1936878X16309755?via%3Dihub | |
dc.identifier.uri | http://qmro.qmul.ac.uk/xmlui/handle/123456789/44403 | |
dc.description | Elsevier Open Archive. Articles featured in the archives are free for everyone to read and download and are made available after an embargo period. | en_US |
dc.description.abstract | Objectives
The aim of this study was to investigate the individual and combined accuracy of dynamic computed tomography (CT) myocardial perfusion imaging (MPI) and computed tomography angiography (CTA) fractional flow reserve (FFR) for the identification of functionally relevant coronary artery disease (CAD).
Background
Coronary CTA has become an established diagnostic test for ruling out CAD, but it does not allow interpretation of the hemodynamic severity of stenotic lesions. Two recently introduced functional CT techniques are dynamic MPI and CTA FFR using computational fluid dynamics.
Methods
From 2 institutions, 74 patients (n = 62 men, mean age 61 years) planned for invasive angiography with invasive FFR measurement in 142 vessels underwent CTA imaging and dynamic CT MPI during adenosine vasodilation. A patient-specific myocardial blood flow index was calculated, normalized to remote myocardial global left ventricular blood flow. CTA FFR was computed using an on-site, clinician-operated application. Using binary regression, a single functional CT variable was created combining both CT MPI and CTA FFR. Finally, stepwise diagnostic work-up of CTA FFR with selective use of CT MPI was simulated. The diagnostic performance of CT MPI, CTA FFR, and CT MPI integrated with CTA FFR was evaluated using C statistics with invasive FFR, with a threshold of 0.80 as a reference.
Results
Sensitivity, specificity, and accuracy were 73% (95% confidence interval [CI]: 61% to 86%), 68% (95% CI: 56% to 80%), and 70% (95% CI: 62% to 79%) for CT MPI and 82% (95% CI: 72% to 92%), 60% (95% CI: 48% to 72%), and 70% (63% to 80%) for CTA FFR. For CT MPI integrated with CTA FFR, diagnostic accuracy was 79% (95% CI: 71% to 87%), with improvement of the area under the curve from 0.78 to 0.85 (p < 0.05). Accuracy of the stepwise approach was 77%.
Conclusions
CT MPI and CTA FFR both identify functionally significant CAD, with comparable accuracy. Diagnostic performance can be improved by combining the techniques. A stepwise approach, reserving CT MPI for intermediate CTA FFR results, also improves diagnostic performance while omitting nearly one-half of the population from CT MPI examinations. | en_US |
dc.description.sponsorship | Drs. Coenen, Lubbers, and Nieman were supportedby a grant from the Dutch Heart Foundation (NHS 2014T061). This workforms part of the translational research portfolio of the National Insti-tute for Health Research Cardiovascular Biomedical Research Unit atBarts, which is supported and funded by the National Institute forHealth Research (Dr. Pugliese). Dr. Rossi is a recipient of a TrainingGrant from the European Society of Cardiology (2014). | en_US |
dc.format.extent | 761 - 770 | |
dc.language.iso | en | en_US |
dc.publisher | Elsevier/Science Direct | en_US |
dc.relation.ispartof | JACC-CARDIOVASCULAR IMAGING | |
dc.relation.isreplacedby | 123456789/19569 | |
dc.relation.isreplacedby | https://qmro.qmul.ac.uk/handle/123456789/19569 | |
dc.rights | All rights reserved | |
dc.subject | coronary artery disease | en_US |
dc.subject | CT angiography | en_US |
dc.subject | CTA FFR | en_US |
dc.subject | CT myocardial perfusion | en_US |
dc.title | Integrating CT Myocardial Perfusion and CT-FFR in the Work-Up of Coronary Artery Disease | en_US |
dc.type | Article | en_US |
dc.rights.holder | AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION | |
pubs.author-url | http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000404543000008&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=612ae0d773dcbdba3046f6df545e9f6a | |
pubs.declined | 2017-09-28T15:29:28.279+0100 | |
pubs.deleted | 2017-09-28T15:29:28.279+0100 | |
pubs.issue | 7 | |
pubs.merge-to | 123456789/19569 | |
pubs.merge-to | https://qmro.qmul.ac.uk/handle/123456789/19569 | |
pubs.publication-status | Published | |
pubs.volume | 10 | |