320-row CT coronary angiography predicts freedom from revascularisation and acts as a gatekeeper to defer invasive angiography in stable coronary artery disease: a fractional flow reserve-correlated study
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- 作者：Brian S. Ko (1) (5)
Dennis T. L. Wong (1)
James D. Cameron (1)
Darryl P. Leong (2) (3)
Michael Leung (1)
Ian T. Meredith (1)
Nitesh Nerlekar (1)
Paul Antonis (1)
Marcus Crossett (1) (4)
John Troupis (1) (4)
Richard Harper (1)
Yuvaraj Malaiapan (1)
Sujith K. Seneviratne (1) - 关键词：Imaging ; Coronary disease ; Ischaemia ; Computed tomography ; Fractional flow reserve ; Quantitative coronary angiography
- 刊名：European Radiology
- 出版年：2014
- 出版时间：March 2014
- 年：2014
- 卷：24
- 期：3
- 页码：738-747
- 全文大小：450 KB
- 作者单位：Brian S. Ko (1) (5)
Dennis T. L. Wong (1)
James D. Cameron (1)
Darryl P. Leong (2) (3)
Michael Leung (1)
Ian T. Meredith (1)
Nitesh Nerlekar (1)
Paul Antonis (1)
Marcus Crossett (1) (4)
John Troupis (1) (4)
Richard Harper (1)
Yuvaraj Malaiapan (1)
Sujith K. Seneviratne (1)
1. Monash Cardiovascular Research Centre, MonashHEART, Department of Medicine Monash Medical Centre (MMC), Southern Health and Monash University, Melbourne, Australia
5. Monash Heart, 246 Clayton Road, Clayton, 3168, VIC, Australia
2. Discipline of Medicine, University of Adelaide, Adelaide, Australia
3. Flinders University, Adelaide, Australia
4. Department of Diagnostic Imaging, MMC, Southern Health and Monash University, Melbourne, Australia - ISSN：1432-1084
文摘
Objectives To determine the accuracy of 320-row multidetector coronary computed tomography angiography (M320-CCTA) to detect functional stenoses using fractional flow reserve (FFR) as the reference standard and to predict revascularisation in stable coronary artery disease. Methods One hundred and fifteen patients (230 vessels) underwent M320-CCTA and FFR assessment and were followed for 18?months. Diameter stenosis on invasive angiography (ICA) and M320-CCTA were assessed by consensus by two observers and significant stenosis was defined as ?0?%. FFR ?.8 indicated functionally significant stenoses. Results M320-CCTA had 94?% sensitivity and 94?% negative predictive value (NPV) for FFR ?.8. Overall accuracy was 70?%, specificity 54?% and positive predictive value 65?%. On receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) for CCTA to predict FFR ?.8 was 0.74 which was comparable with ICA. The absence of a significant stenosis on M320-CCTA was associated with a 6?% revascularisation rate. M320-CCTA predicted revascularisation with an AUC of 0.71 which was comparable with ICA. Conclusions M320-CCTA has excellent sensitivity and NPV for functional stenoses and therefore may act as an effective gatekeeper to defer ICA and revascularisation. Like ICA, M320-CCTA lacks specificity for functional stenoses and only has moderate accuracy to predict the need for revascularisation. Key Points -Important information about the heart is provided by 320-row multidetector CT coronary angiography (M320-CCTA). -M320-CCTA accurately detects and excludes functional stenoses determined by fractional flow reserve (FFR). -Non-significant stenoses on M320-CCTA associated with fewer cardiac events and less revascularisation. -M320-CCTA may act as a gatekeeper for invasive angiography and inappropriate revascularisation. -Like ICA, M320-CCTA only has moderate accuracy to predict vessels requiring revascularisation.