Coronary interventions

One-step anatomic and function testing by cardiac CT versus second-line functional testing in symptomatic patients with coronary artery stenosis: head-to-head comparison of CT-derived fractional flow reserve and myocardial perfusion imaging

EuroIntervention 2021;17:576-583. DOI: 10.4244/EIJ-D-20-00905

Jelmer Westra
Jelmer Westra1,2, MD; Zehang Li2, BSc; Laust Dupont Rasmussen3, MD; Simon Winther3, MD, PhD; Guanyu Li2, BSc; Louise Nissen3, MD, PhD; Steffen E. Petersen4,5, MSc, MPH, MD, DPhil; June Anita Ejlersen6, MD, PhD; Christin Isaksen7, MD; Lars Christian Gormsen8, MD, PhD; Grazina Urbonaviciene7, MD, PhD; Ashkan Eftekhari1, MD, PhD; Tingwen Weng9, MD; Xinkai Qu9, MD, PhD; Hans Erik Bøtker1, MD, PhD, DMSci; Evald Høj Christiansen1, MD, PhD; Niels Ramsing Holm1, MD; Morten Bøttcher3, MD, PhD; Shengxian Tu2, PhD
1. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; 2. School of Biochemical engineering, Shanghai Jiao Tong University, Shanghai, China; 3. Department of Cardiology, Hospital Unit West Jutland, Herning, Denmark; 4. Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; 5. William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom; 6. Department of Nuclear Medicine, Hospital Unit West Jutland, Herning Denmark; 7. Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark; 8. Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark; 9. Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China

Background: CT-QFR is a novel coronary computed tomography angiography (CTA)-based method for on-site evaluation of patients with suspected obstructive coronary artery disease (CAD).

Aims: We aimed to compare the diagnostic performance of CT-QFR with myocardial perfusion scintigraphy (MPS) and cardiovascular magnetic resonance (CMR) as second-line tests in patients with suspected obstructive CAD after coronary CTA.

Methods: A paired analysis of CT-QFR and MPS or CMR, with an invasive FFR-based classification as reference standard was carried out. Symptomatic patients with >50% diameter stenosis on coronary CTA were randomised to MPS or CMR and referred for invasive coronary angiography.

Results: The rate of coronary CTA not feasible for CT-QFR analysis was 17%. Paired patient-level data were available for 118 patients in the MPS group and 113 in the CMR group. Patient-level diagnostic accuracy was better for CT-QFR than for both MPS (82.2% [95% CI: 75.2-89.2] vs 70.3% [95% CI: 62.0-78.7], p=0.029) and CMR (77.0% [95% CI: 69.1-84.9] vs 65.5% [95% CI: 56.6-74.4], p=0.047). Following a positive coronary CTA and with the intention to diagnose, CT-QFR, CMR and MPS were equally suitable as rule-in and rule-out modalities.

Conclusions: The diagnostic performance of CT-QFR as a second-line test was at least similar to MPS and CMR for the evaluation of obstructive CAD in symptomatic patients presenting with ≥50% diameter stenosis on coronary CTA.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

non-invasive imagingfractional flow reservestable angina
Coronary interventionsStable CAD
Read next article
Computer-based prediction of coronary artery compression in the planning of transcatheter pulmonary valve implantation

Latest news