The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)
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
Jelmer Westra1,2; Zehang Li2; Laust Dupont Rasmussen3; Simon Winther3; Guanyu Li2; Louise Nissen3; Steffen E Petersen4,5; June Anita Ejlersen6; Christin Isaksen7; Lars Christian Gormsen8; Grazina Urbonaviciene7; Ashkan Eftekhari1; Tingwen Weng9; Xinkai Qu9; Hans Erik Bøtker1; Evald Høj Christiansen1; Niels Ramsing Holm1; Morten Bøttcher3; Shengxian Tu2;
1. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark 2.School of Biochemical engineering, Shanghai Jioa 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
As a public service to our readership, this article - peer reviewed by the Editors of EuroIntervention and external reviewers - has been published immediately upon acceptance as it was received in the last round of revision. The content of this article is the responsibility of the authors.
Please note that supplementary movies are not available online at this stage. Once a paper is published in its edited and formatted form, it will be accompanied online by any supplementary movies.
To read the full content of this article, please log in to download the PDF.
Aims: 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). We compared 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 and results: Paired analysis of CT-QFR and MPS or CMR, with an invasive FFR-based classification as reference standard. Symptomatic patients with >50% diameter stenosis on coronary CTA were randomized to MPS or CMR and referred for invasive coronary angiography. 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, respectively. 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 second-line test was at least similar to MPS and CMR for the evaluation of obstructive coronary artery disease in symptomatic patients presenting with ³50% diameter stenosis on coronary CTA.