Author + information
- Received February 12, 2016
- Revision received April 27, 2016
- Accepted May 4, 2016
- Published online April 3, 2017.
- Sara Gaur, MD, PhDa,∗ (, )
- Charles A. Taylor, PhDb,c,
- Jesper M. Jensen, MD, PhDa,
- Hans Erik Bøtker, MD, PhD, DMSca,
- Evald H. Christiansen, MD, PhDa,
- Anne K. Kaltoft, MD, PhDa,
- Niels R. Holm, MDa,
- Jonathon Leipsic, MDd,
- Christopher K. Zarins, MDb,e,
- Stephan Achenbach, MD, PhDf,
- Sophie Khem, MSb,
- Alan Wilk, BSb,
- Hiram G. Bezerra, MD, PhDg,
- Jens F. Lassen, MD, PhDa and
- Bjarne L. Nørgaard, MD, PhDa
- aDepartment of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- bHeartFlow, Inc., Redwood City, California
- cDepartment of Bioengineering, Stanford University, Stanford, California
- dDepartment of Radiology and Division of Cardiology, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- eDepartment of Surgery, Stanford University, Stanford, California
- fDepartment of Cardiology, University of Erlangen, Erlangen, Germany
- gCardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, Case Medical Center, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Sara Gaur, Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark 8200, Denmark.
Objectives This study sought to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) for the diagnosis of lesion-specific ischemia in nonculprit vessels of patients with recent in ST-segment elevation myocardial infarction (STEMI).
Background In patients with stable angina, FFRCT has high diagnostic performance in identification of ischemia-causing lesions. The potential value of FFRCT for assessment of multivessel disease in patients with recent STEMI has not been evaluated.
Methods Coronary CTA with calculation of FFRCT and invasive coronary angiography with FFR were performed 1 month after STEMI in patients with multivessel disease. Coronary CTA and invasive coronary angiography stenosis >50% were considered obstructive. Lesion-specific ischemia was assumed if FFRCT was ≤0.80. FFR ≤0.80 was the reference standard. To evaluate the influence of vessel size, the total coronary vessel lumen volume relative to left ventricular mass (volume-to-mass ratio) was calculated and compared with that of patients with stable angina.
Results The study evaluated 124 nonculprit vessels from 60 patients. Accuracy, sensitivity, and specificity of FFRCT were 72%, 83%, and 66% versus 64% (p = 0.033), 93% (p = 0.15), and 49% (p < 0.001) for CTA and 72% (p = 1.00), 76% (p = 0.46), and 70% (p = 0.54) for invasive coronary angiography. Following STEMI, median volume-to-mass ratio was lower than in patients with stable angina, 53 versus 65 mm3/g (p = 0.009). In patients with volume-to-mass ratio ≥65 mm3/g (upper tertile) accuracy, sensitivity, and specificity of FFRCT were all 83% versus 56% (p = 0.009), 75% (p = 0.61), and 44% (p = 0.003) in patients with <49 mm3/g (lower tertile).
Conclusions The diagnostic performance of FFRCT for staged detection of ischemia in STEMI patients with multivessel disease is moderate. STEMI patients have a smaller vessel volume than do patients with stable angina. The diagnostic performance of FFRCT is influenced by the volume-to-mass ratio. This study does not support routine use of FFRCT in the post-STEMI setting. (Assessment of Coronary Stenoses Using Coronary CT-Angiography and Noninvasive Fractional Flow Reserve; NCT01739075)
- coronary computed tomography angiography
- fractional flow reserve
- nonculprit lesion
- ST-segment elevation myocardial infarction
Drs. Taylor and Zarins are founders, employees, and shareholders of HeartFlow. Dr. Jensen has received speaker's honorarium from Bracco Imaging. Dr. Christiansen has received research grants from St. Jude Medical. Dr. Holm has received institutional research grants from St. Jude Medical, Medis Medical Imaging, and Boston Scientific. Dr. Leipsic serves as a consultant for GE Healthcare, Edwards Lifesciences, HeartFlow, Samsung, Philips, and Circle Cardiovascular Imaging. Dr. Achenbach has received institutional research grants from Siemens Healthcare and Abbott Vascular. Ms. Khem and Mr. Wilk are employees of HeartFlow. Dr. Lassen has received research grants from St. Jude Medical, Biosensors, Biotronik, Boston Scientific, Radi, Terumo, and Volcano. Dr. Nørgaard has received institutional research grants from Siemens Healthcare, Edwards Lifesciences, and HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 12, 2016.
- Revision received April 27, 2016.
- Accepted May 4, 2016.
- 2017 American College of Cardiology Foundation