Influence of Coronary Calcification on the聽Diagnostic Performance of CT Angiography Derived FFR in Coronary聽Artery Disease: A Substudy of the NXT Trial

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• 作者：Bjarne L. Nø ; rgaard ; MD ; PhD^&lowast ; ; ^{bnorgaard@dadlnet.dk" class="auth_mail" title="E-mail the corresponding author} ; Sara Gaur ; MD^&lowast ; ; Jonathon Leipsic ; MD ; PhD^&dagger ; ; Hiroshi Ito ; MD ; PhD^&Dagger ; ; Toru Miyoshi ; MD ; PhD^&Dagger ; ; Seung-Jung Park ; MD ; PhD^§ ; ; Ligita Zvaigzne ; MD^鈥?/sup> ; Nikolaos Tzemos ; MD ; PhD^¶ ; ; Jesper M. Jensen ; MD ; PhD^&lowast ; ; Nicolaj Hansson ; MD^&lowast ; ; Brian Ko ; MBBS ; PhD^# ; Hiram Bezerra ; MD ; PhD^&lowast ; &lowast ; ; Evald H. Christiansen ; MD ; PhD^&lowast ; ; Anne Kaltoft ; MD ; PhD^&lowast ; ; Jens F. Lassen ; MD ; PhD^&lowast ; ; Hans Erik Bø ; tker ; MD ; DMSci^&lowast ; ; Stephan Achenbach ; MD ; PhD^&dagger ; &dagger ;
• 关键词：computed tomography angiography ; coronary angiography ; coronary artery disease ; coronary calcification ; fractional flow reserve
• 刊名：JACC: Cardiovascular Imaging
• 出版年：2015
• 出版时间：September 2015
• 年：2015
• 卷：8
• 期：9
• 页码：1045-1055
• 全文大小：732 K

文摘

The goal of this study was to examine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFR_CT) in relation to coronary calcification severity.

Background

FFR_CT has shown promising results in identifying lesion-specific ischemia. The extent to which the severity of coronary calcification affects the diagnostic performance of FFR_CT is not known.

Methods

Coronary calcification was assessed by using the Agatston score (AS) in 214 patients suspected of having coronary artery disease who underwent coronary CTA, FFR_CT, and FFR (FFR examination was performed in 333 vessels). The diagnostic performance of FFR_CT (≤0.80) in identifying vessel-specific ischemia (FFR ≤0.80) was investigated across AS quartiles (Q1 to Q4) and for discrimination of ischemia in patients and vessels with a low-mid AS (Q1 to Q3) versus a high AS (Q4). Coronary CTA stenosis was defined as lumen reduction >50%.

Results

Mean ± SD per-patient and per-vessel AS were 302 ± 468 (range 0 to 3,599) and 95 ± 172 (range 0 to 1,703), respectively. There was no statistical difference in diagnostic accuracy, sensitivity, or specificity of FFR_CT across AS quartiles. Discrimination of ischemia by FFR_CT was high in patients with a high AS (416 to 3,599) and a low-mid AS (0 to 415), with no difference in area under the receiver-operating characteristic curve (AUC) (0.86 [95% confidence interval (CI): 0.76 to 0.96] vs. 0.92 [95% CI: 0.88 to 0.96]) (p = 0.45). Similarly, discrimination of ischemia by FFR_CT was high in vessels with a high AS (121 to 1,703) and a low-mid AS (0 to 120) (AUC: 0.91 [95% CI: 0.85 to 0.97] vs. 0.95 [95% CI: 0.91 to 0.98]; p = 0.65). Diagnostic accuracy and specificity of FFR_CT were significantly higher than for stenosis assessment in each AS quartile at the per-patient (p < 0.001) and per-vessel (p < 0.05) level with similar sensitivity. In vessels with a high AS, FFR_CT exhibited improved discrimination of ischemia compared with coronary CTA alone (AUC: 0.91 vs. 0.71; p = 0.004), whereas on a per-patient level, the difference did not reach statistical significance (AUC: 0.86 vs. 0.72; p = 0.09).

Conclusions

FFR_CT provided high and superior diagnostic performance compared with coronary CTA interpretation alone in patients and vessels with a high AS.