Author + information
- Received July 18, 2012
- Revision received September 20, 2012
- Accepted September 24, 2012
- Published online November 1, 2012.
- Brian S. Ko, MBBS⁎,
- James D. Cameron, MD⁎,
- Michael Leung, PhD⁎,
- Ian T. Meredith, PhD⁎,
- Darryl P. Leong, PhD†,
- Paul R. Antonis, MBBS⁎,
- Marcus Crossett, BSc⁎,‡,
- John Troupis, MBBS⁎,‡,
- Richard Harper, MBBS⁎,
- Yuvaraj Malaiapan, MBBS⁎ and
- Sujith K. Seneviratne, MBBS⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Sujith K. Seneviratne, MonashHeart, 246 Clayton Road, Clayton, 3168 Victoria, Australia
Objectives We sought to determine the accuracy of combined coronary computed tomography angiography (CTA) and computed tomography stress myocardial perfusion imaging (CTP) in the detection of hemodynamically significant stenoses using fractional flow reserve (FFR) as a reference standard in patients with suspected coronary artery disease.
Background CTP can be qualitatively assessed by visual interpretation or quantified by the transmural perfusion ratio determined as the ratio of subendocardial to subepicardial contrast attenuation. The incremental value of each technique in addition to coronary CTA to detect hemodynamically significant stenoses is not known.
Methods Forty symptomatic patients underwent FFR and 320-detector computed tomography assessment including coronary CTA and CTP. Myocardial perfusion was assessed using the transmural perfusion ratio and visual perfusion assessment. Computed tomography images were assessed by consensus of 2 observers. Transmural perfusion ratio <0.99 was used as the threshold for abnormal perfusion. FFR ≤0.8 indicated hemodynamically significant stenoses.
Results Coronary CTA detected FFR-significant stenoses with 95% sensitivity and 78% specificity. The additional use of visual perfusion assessment and the transmural perfusion ratio both increased the specificity to 95%, with sensitivity of 87% and 71%, respectively. The area under the receiver-operating characteristic curve for coronary CTA + visual perfusion assessment was significantly higher than both coronary CTA (0.93 vs. 0.85, p = 0.0003) and coronary CTA + the transmural perfusion ratio (0.93 vs. 0.79, p = 0.0003). Per-vessel and per-patient accuracy for coronary CTA, coronary CTA + the transmural perfusion ratio, and coronary CTA + visual perfusion assessment was 83% and 83%, 87% and 92%, and 92% and 95%, respectively.
Conclusions In suspected coronary artery disease, combined coronary CTA + CTP identifies patients with hemodynamically significant stenoses with >90% accuracy compared with FFR. When interpreted with coronary CTA, visual perfusion assessment provided superior incremental value in the detection of FFR-significant stenoses compared with the quantitative transmural perfusion ratio assessment.
- computed tomography
- coronary disease
- fractional flow reserve
- quantitative coronary angiography
Dr. Ko is supported by a scholarship funded by the Royal Australasian College of Physicians. Dr. Leong is supported by a training fellowship cofunded by the National Health and Medical Research Council of Australia and the National Heart Foundation of Australia. Dr. Seneviratne has been a speaker at meetings sponsored by Toshiba. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 18, 2012.
- Revision received September 20, 2012.
- Accepted September 24, 2012.
- American College of Cardiology Foundation