Author + information
- Niels Peter Rønnow Sand, MD, PhDa,b,∗ (, )
- Louise Nissen, MDc,
- Simon Winther, MD, PhDc,d,
- Steffen E. Petersen, MD, PhD, MSc, MPHe,f,
- Jelmer Westra, MDd,
- Evald H. Christiansen, MD, PhDd,
- Pia Larsen, PhDg,
- Niels R. Holm, MD, PhDd,
- Christin Isaksen, MDh,
- Grazina Urbonaviciene, MDi,
- Lone Deibjerg, MDa,
- Majed Husain, MD, MSca,
- Kristian K. Thomsen, MD, PhDa,
- Allan Rohold, MD, PhDa,
- Hans Erik Bøtker, MD, PhD, DMScid and
- Morten Bøttcher, MD, PhDc
- aDepartment of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark
- bInstitute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- cDepartment of Cardiology, Hospital Unit West Jutland, Herning, Denmark
- dDepartment of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
- eWilliam Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- fBarts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
- gDepartment of Epidemiology and Biostatistics, University of Southern Denmark, Odense, Denmark
- hDepartment of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
- iDepartment of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
- ↵∗Address for correspondence:
Dr. Rønnow Sand, Department of Cardiology, Hospital of Southwest Denmark, Finsensgade 35, 6700 Esbjerg, Denmark.
Objectives This study was designed to compare head-to-head fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) and cardiac magnetic resonance (CMR) stress perfusion imaging for prediction of standard-of-care–guided coronary revascularization in patients with stable chest pain and obstructive coronary artery disease by coronary CTA.
Background FFRCT is a novel modality for noninvasive functional testing. The clinical utility of FFRCT compared to CMR stress perfusion imaging in symptomatic patients with coronary artery disease is unknown.
Methods Prospective study of patients (n=110) with stable angina pectoris and 1 or more coronary stenosis ≥50% by coronary CTA. All patients underwent invasive coronary angiography. Revascularization was FFR-guided in stenoses ranging from 30% to 90%. FFRCT ≤0.80 in 1 or more coronary artery or a reversible perfusion defect (≥2 segments) by CMR categorized patients with ischemia. FFRCT and CMR were analyzed by core laboratories blinded for patient management.
Results A total of 38 patients (35%) underwent revascularization. Per-patient diagnostic performance for identifying standard-of-care–guided revascularization, (95% confidence interval) yielded a sensitivity of 97% (86 to 100) for FFRCT versus 47% (31 to 64) for CMR, p < 0.001; corresponding specificity was 42% (30 to 54) versus 88% (78 to 94), p < 0.001; negative predictive value of 97% (91 to 100) versus 76% (67 to 85), p < 0.05; positive predictive value of 47% (36 to 58) versus 67% (49 to 84), p < 0.05; and accuracy of 61% (51 to 70) versus 74% (64 to 82), p > 0.05, respectively.
Conclusions In patients with stable chest pain referred to invasive coronary angiography based on coronary CTA, FFRCT and CMR yielded similar overall diagnostic accuracy. Sensitivity for prediction of revascularization was highest for FFRCT, whereas specificity was highest for CMR.
- cardiac magnetic resonance stress perfusion imaging
- coronary computed tomography angiography–derived fractional flow reserve
- stable angina
This study was supported by the Danish Heart Foundation (grant no. 15-R99-A5837-22920) and the Health Research Fund of Central Denmark Region. Dr. Petersen has received grants from the National Institute for Health Research Biomedical Research Centre at Barts; and has received consulting fees from and own shares in Circle Cardiovascular Imaging, Inc. Dr. Holm has received grants from Abbott and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 30, 2019.
- Revision received May 20, 2019.
- Accepted June 28, 2019.
- 2019 The Authors