Author + information
- Received March 19, 2018
- Revision received August 16, 2018
- Accepted August 17, 2018
- Published online October 17, 2018.
- Gianluca Pontone, MD, PhDa,∗ (, )
- Andrea Baggiano, MDa,
- Daniele Andreini, MD, PhDa,b,
- Andrea I. Guaricci, MDc,d,
- Marco Guglielmo, MDa,
- Giuseppe Muscogiuri, MDa,
- Laura Fusini, MDa,
- Fabio Fazzari, MDe,
- Saima Mushtaq, MDa,
- Edoardo Conte, MDa,
- Giuseppe Calligaris, MDa,
- Stefano De Martini, MDa,
- Cristina Ferrari, MDa,
- Stefano Galli, MDa,
- Luca Grancini, MDa,
- Paolo Ravagnani, MDa,
- Giovanni Teruzzi, MDa,
- Daniela Trabattoni, MDa,
- Franco Fabbiocchi, MDa,
- Alessandro Lualdi, MDa,b,
- Piero Montorsi, MDa,b,
- Mark G. Rabbat, MDf,g,
- Antonio L. Bartorelli, MDa,h and
- Mauro Pepi, MDa
- aCentro Cardiologico Monzino, IRCCS, Milan, Italy
- bDepartment of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
- cDepartment of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico of Bari, Bari, Italy
- dDepartment of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- eDepartment of Cardiology, University Hospital P. Giaccone, Palermo, Italy
- fLoyola University of Chicago, Chicago, Illinois
- gEdward Hines Jr. VA Hospital, Hines, Illinois
- hDepartment of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
- ↵∗Address for correspondence:
Dr. Gianluca Pontone, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy.
Objectives This study sought to compare the diagnostic accuracy of coronary computed tomography angiography (cCTA) with that of cCTA+fractional flow reserve derived from cCTA datasets (FFRCT) and that of cCTA+static stress-computed tomography perfusion (stress-CTP) in detecting functionally significant coronary artery lesions using invasive coronary angiography (ICA) plus invasive FFR as the reference standard.
Background FFRCT and static stress-CTP are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using cCTA.
Methods A total of 147 consecutive symptomatic patients scheduled for clinically indicated ICA+invasive FFR were evaluated with cCTA, FFRCT, and stress-CTP.
Results Vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values, and accuracy rates of cCTA were 99%, 76%, 100%, 61%, 82%, and 95%, 54%, 94%, 63%, 73%, respectively. cCTA+FFRCT showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 88%, 94%, 95%, 84%, 92%, and 90%, 85%, 92%, 83%, 87%, respectively. Finally, cCTA+stress-CTP showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 92%, 95%, 97%, 87%, 94% and 98%, 87%, 99%, 86%, 92%, respectively. Both FFRCT and stress-CTP significantly improved specificity and positive predictive values compared to those of cCTA alone. The area under the curve to detect flow-limiting stenoses of cCTA, cCTA+FFRCT, and cCTA+CTP were 0.89, 0.93, 0.92, and 0.90, 0.94, and 0.93 in a vessel-based and patient-based model, respectively, with significant additional values for both cCTA+FFRCT and cCTA+CTP versus cCTA alone (p < 0.001) but no differences between cCTA+FFRCT versus cCTA+CTP.
Conclusions FFRCT and stress-CTP in addition to cCTA are valid and comparable tools to evaluate the functional relevance of CAD.
Supported by the Current Research Program of Italian Ministry of Health, Rome, Italy. Dr. Pontone has received research support and speaker honoraria from General Electric Health, Bracco, Medtronic, Bayer, and Heartflow. Dr. Andreini has received research support through his institution; and speaker honoraria from General Electric Health, Bracco, and Heartflow. All other authors have reported that they have no relationships with industry relevant to the contents of this paper to disclose.
- Received March 19, 2018.
- Revision received August 16, 2018.
- Accepted August 17, 2018.
- 2018 American College of Cardiology Foundation
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