Author + information
- Received March 23, 2018
- Revision received May 4, 2018
- Accepted May 9, 2018
- Published online November 5, 2018.
- Niels Peter Rønnow Sand, MDa,b,∗ (, )
- Karsten Tange Veien, MDc,
- Søren Steen Nielsen, MDd,
- Bjarne Linde Nørgaard, MDe,
- Pia Larsen, PhDf,
- Allan Johansen, MDg,
- Søren Hess, MDh,
- Lone Deibjerg, MDa,
- Majed Husain, MDa,
- Anders Junker, MDc,
- Kristian Korsgaard Thomsen, MDa,
- Allan Rohold, MDa and
- Lisette Okkels Jensen, MDc
- aDepartment of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark
- bInstitute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- cDepartment of Cardiology, Odense University Hospital, Odense, Denmark
- dDepartment of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
- eDepartment of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
- fDepartment of Epidemiology, Biostatistics and Bioinformatics, University of Southern Denmark, Odense, Denmark
- gDepartment of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- hDepartment of Radiology and Nuclear Medicine, Hospital of Southwest Denmark, Esbjerg, Denmark
- ↵∗Address for correspondence:
Dr. Niels Peter Rønnow Sand, Hospital of Southwest Denmark, Department of Cardiology, Finsensgade 35, 6700 Esbjerg, Denmark.
Objectives This study sought to compare the per-patient diagnostic performance of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT) with that of single-photon emission computed tomography (SPECT), using a fractional flow reserve (FFR) value of ≤0.80 as the reference for diagnosing at least 1 hemodynamically significant stenosis in a head-to-head comparison of patients with intermediate coronary stenosis as determined by coronary CTA.
Background No previous study has prospectively compared the diagnostic performance of FFRCT and myocardial perfusion imaging by SPECT in symptomatic patients with intermediate range coronary artery disease (CAD).
Methods This study was conducted at a single-center as a prospective study in patients with stable angina pectoris (N = 143). FFRCT and SPECT analyses were performed by core laboratories and were blinded for the personnel responsible for downstream patient management. FFRCT ≤0.80 distally in at least 1 coronary artery with a diameter ≥2 mm classified patients as having ischemia. Ischemia by SPECT was encountered if a reversible perfusion defect (summed difference score ≥2) or transitory ischemic dilation of the left ventricle (ratio >1.19) were found.
Results The per-patient diagnostic performance for identifying ischemia (95% confidence interval [CI]), FFRCT versus SPECT, were sensitivity of 91% (95% CI: 81% to 97%) versus 41% (95% CI: 29% to 55%; p < 0.001); specificity of 55% (95% CI: 44% to 66%) versus 86% (95% CI: 77% to 93%; p < 0.001); negative predictive value of 90% (95% CI: 82% to 98%) versus 68% (95% CI: 59% to 77%; p = 0.001); positive predictive value of 58% (95% CI: 48% to 68%) versus 67% (95% CI: 51% to 82%; p = NS); and accuracy of 70% (95% CI: 62% to 77%) versus 68% (95% CI: 60% to 75%; p = NS) respectively.
Conclusions In patients with stable chest pain and CAD as determined by coronary CTA, the overall diagnostic accuracy levels of FFRCT and SPECT were identical in assessing hemodynamically significant stenosis. However, FFRCT demonstrated a significantly higher diagnostic sensitivity than SPECT.
Supported by participating departments. No external funding was used. Dr. Nørgaard has received institutional research grants from Siemens, Edwards LifeSciences, and HeartFlow. Dr. Jensen has received institutional research grants from St. Jude Medical, Biosensors, and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 23, 2018.
- Revision received May 4, 2018.
- Accepted May 9, 2018.
- 2018 The Authors