Author + information
- Received September 20, 2019
- Revision received December 12, 2019
- Accepted February 5, 2020
- Published online September 7, 2020.
- Pepijn A. van Diemen, MDa,
- Roel S. Driessen, MDa,
- Rolf A. Kooistra, PhDb,
- Wynand J. Stuijfzand, MDa,
- Pieter G. Raijmakers, MD, PhDc,
- Ronald Boellaard, MD, PhDc,
- Stefan P. Schumacher, MDa,
- Michiel J. Bom, MDa,
- Henk Everaars, MDa,
- Ruben W. de Winter, MDa,
- Peter M. van de Ven, PhDd,
- Johan H. Reiber, MD, PhDb,
- James K. Min, MDe,
- Jonathan A. Leipsic, MDf,
- Juhani Knuuti, MD, PhDg,
- Richard S. Underwood, MD, PhDh,
- Albert C. van Rossum, MD, PhDa,
- Ibrahim Danad, MD, PhDa and
- Paul Knaapen, MD, PhDa,∗ ()
- aDepartment of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- bMedis Medical Imaging Systems, Leiden, the Netherlands
- cDepartment of Radiology, Nuclear Medicine, and PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- dDepartment of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- eInstitute for Cardiovascular Imaging, Weill-Cornell Medical College, New York-Presbyterian Hospital, New York, New York
- fDepartment of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- gTurku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
- hDepartment of Nuclear Medicine, Royal Brompton Hospital, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Paul Knaapen, Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
Objectives This study compared the performance of the quantitative flow ratio (QFR) with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) myocardial perfusion imaging (MPI) for the diagnosis of fractional flow reserve (FFR)−defined coronary artery disease (CAD).
Background QFR estimates FFR solely based on cine contrast images acquired during invasive coronary angiography (ICA). Head-to-head studies comparing QFR with noninvasive MPI are lacking.
Methods A total of 208 (624 vessels) patients underwent technetium-99m tetrofosmin SPECT and [15O]H2O PET imaging before ICA in conjunction with FFR measurements. ICA was obtained without using a dedicated QFR acquisition protocol, and QFR computation was attempted in all vessels interrogated by FFR (552 vessels).
Results QFR computation succeeded in 286 (52%) vessels. QFR correlated well with invasive FFR overall (R = 0.79; p < 0.001) and in the subset of vessels with an intermediate (30% to 90%) diameter stenosis (R = 0.76; p < 0.001). Overall, per-vessel analysis demonstrated QFR to exhibit a superior sensitivity (70%) in comparison with SPECT (29%; p < 0.001), whereas it was similar to PET (75%; p = 1.000). Specificity of QFR (93%) was higher than PET (79%; p < 0.001) and not different from SPECT (96%; p = 1.000). As such, the accuracy of QFR (88%) was superior to both SPECT (82%; p = 0.010) and PET (78%; p = 0.004). Lastly, the area under the receiver operating characteristics curve of QFR, in the overall sample (0.94) and among vessels with an intermediate lesion (0.90) was higher than SPECT (0.63 and 0.61; p < 0.001 for both) and PET (0.82; p < 0.001 and 0.77; p = 0.002), respectively.
Conclusions In this head-to-head comparative study, QFR exhibited a higher diagnostic value for detecting FFR-defined significant CAD compared with perfusion imaging by SPECT or PET.
- fractional flow reserve
- positron emission tomography
- quantitative flow ratio
- single-photon emission computed tomography
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. James Udelson, MD, served as Guest Editor for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received September 20, 2019.
- Revision received December 12, 2019.
- Accepted February 5, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.