Additional diagnostic value of new CT imaging techniques for the functional assessment of coronary artery disease: a meta-analysis

Hamon, M.; Geindreau, Damien; Guittet, Lydia; Bauters, Christophe; Hamon, Martial

doi:10.1007/s00330-018-5919-8

Cited by 23 publications

(55 citation statements)

References 78 publications

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“…CT-MPI allows for visualization or measurement of the regional myocardial blood flow during vasodilator-induced hyperemia. Several studies have shown similar diagnostic performance between CT-MPI and CT-FFR [26,33,34]. Also in this cohort, CT-FFR performed at least equally well as CT-MPI, but could not be performed in patients with suspected total coronary occlusions or insufficient CCTA imaging quality.…”

Section: Comparison Between Ct-ffr and Ct-mpisupporting

confidence: 50%

“…Current European guidelines recommend additional functional testing in patients with ≥ 50% stenosis on CCTA; therefore, we restricted the CT-FFR analysis to those with ≥ 50% stenosis on CCTA [1]. Moreover, it has been suggested that CT-FFR is not of incremental value over CCTA in patients with < 50% stenosis on CCTA, as the vast majority of these lesions are not hemodynamically significant [20,25,26]. However, hemodynamically significant disease cannot completely be ruled out in patients with stenosis < 50% and CT-FFR could be valuable in specific cases.…”

Section: Medical Managementmentioning

confidence: 99%

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Impact of machine-learning CT-derived fractional flow reserve for the diagnosis and management of coronary artery disease in the randomized CRESCENT trials

et al. 2020

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Objective To determine the potential impact of on-site CT-derived fractional flow reserve (CT-FFR) on the diagnostic efficiency and effectiveness of coronary CT angiography (CCTA) in patients with obstructive coronary artery disease (CAD) on CCTA. Methods This observational cohort study included patients with suspected CAD who had been randomized to cardiac CT in the CRESCENT I and II trials. On-site CT-FFR was blindly performed in all patients with at least one ≥ 50% stenosis on CCTA and no exclusion criteria for CT-FFR. We retrospectively assessed the effect of adding CT-FFR to the CT protocol in patients with a stenosis ≥ 50% on CCTA in terms of diagnostic effectiveness, i.e., the number of additional tests required to determine the final diagnosis, reclassification of the initial management strategy, and invasive coronary angiography (ICA) efficiency, i.e., ICA rate without ≥ 50% CAD. Results Fifty-three patients out of the 372 patients (14%) had at least one ≥ 50% stenosis on CCTA of whom 42/53 patients (79%) had no exclusion criteria for CT-FFR. CT-FFR showed a hemodynamically significant stenosis (≤ 0.80) in 27/53 patients (51%). The availability of CT-FFR would have reduced the number of patients requiring additional testing by 57%-points compared with CCTA alone (37/53 vs. 7/53, p < 0.001). The initial management strategy would have changed for 30 patients (57%, p < 0.001). Reserving ICA for patients with a CT-FFR ≤ 0.80 would have reduced the number of ICA following CCTA by 13%-points (p = 0.016). Conclusion Implementation of on-site CT-FFR may change management and improve diagnostic efficiency and effectiveness in patients with obstructive CAD on CCTA. Key Points • The availability of on-site CT-FFR in the diagnostic evaluation of patients with obstructive CAD on CCTA would have significantly reduced the number of patients requiring additional testing compared with CCTA alone. • The implementation of on-site CT-FFR would have changed the initial management strategy significantly in the patients with obstructive CAD on CCTA. • Restricting ICA to patients with a positive CT-FFR would have significantly reduced the ICA rate in patients with obstructive CAD on CCTA.

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Section: Comparison Between Ct-ffr and Ct-mpisupporting

confidence: 50%

Section: Medical Managementmentioning

confidence: 99%

Impact of machine-learning CT-derived fractional flow reserve for the diagnosis and management of coronary artery disease in the randomized CRESCENT trials

et al. 2020

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“…CTP is not widely available because it requires a high level of expertise and multiple resources, including advanced scanners and reconstruction algorithms. Greater radiation exposure, use of a higher contrast dose compared with CTA alone (static CTP alone 1.9-15.7 mSv, dynamic CTP alone 3.8-12.8 mSv, combined CTA and stress CTP protocol 3-16 mSv) [37,84], and side effects of medications are also issues. Static CTP is limited in evaluation of patients after CABG because of the complexity of myocardial perfusion via the native coronary arteries and bypass grafts.…”

Section: Limitations Of Ctpmentioning

confidence: 99%

“…Multiple studies have established the high diagnostic performance of both static and dynamic CTP for detecting hemodynamically significant stenosis [34,36,41,61,62,78,81,[84][85][86][87][88][89][90] (Table 2). Recent meta-analyses indicated that dynamic CTP has higher sensitivity but lower specificity than static CTP (sensitivity, 85% vs 72-80%; specificity, 90-93% vs 81-83%) [84,90] (Table 2). Moreover, the CORE320 study (n = 381) demonstrated that static CTP has incremental diagnostic value over CTA for detection of hemodynamically significant coronary lesions, with a specificity of 74% vs 51% for CTA, a PPV of 65% vs 53%, and an area under the receiver-operating characteristic curve (AUC) of 0.87 vs 0.84 [91].…”

Section: Current Evidence Of Ctpmentioning

confidence: 99%

Computed tomographic evaluation of myocardial ischemia

et al. 2020

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Myocardial ischemia is caused by a mismatch between myocardial oxygen consumption and oxygen delivery in coronary artery disease (CAD). Stratification and decision-making based on ischemia improves the prognosis in patients with CAD. Non-invasive tests used to evaluate myocardial ischemia include stress electrocardiography, echocardiography, single-photon emission computed tomography, and magnetic resonance imaging. Invasive fractional flow reserve is considered the reference standard for assessment of the hemodynamic significance of CAD. Computed tomography (CT) angiography has emerged as a first-line imaging modality for evaluation of CAD, particularly in the population at low to intermediate risk, because of its high negative predictive value; however, CT angiography does not provide information on the hemodynamic significance of stenosis, which lowers its specificity. Emerging techniques, e.g., CT perfusion and CT-fractional flow reserve, help to address this limitation of CT, by determining the hemodynamic significance of coronary artery stenosis. CT perfusion involves acquisition during the first pass of contrast medium through the myocardium following pharmacological stress. CTfractional flow reserve uses computational fluid dynamics to model coronary flow, pressure, and resistance. In this article, we review these two functional CT techniques in the evaluation of myocardial ischemia, including their principles, technology, advantages, limitations, pitfalls, and the current evidence.

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“…Myocardial computed tomography perfusion (CTP) imaging has emerged as a non-invasive technique for myocardial perfusion imaging 1 3 [5,6]. Moreover, dynamic myocardial CTP imaging allows to provide quantitative hemodynamic parameters such as computed tomography-derived myocardial blood flow (CT-MBF) [5][6][7]. However, CT-MBF varies between individuals even in the normal myocardium [8,9], and the standardized cutoff has not been established yet.…”

Section: Introductionmentioning

confidence: 99%

Coronary artery stenosis-related perfusion ratio using dynamic computed tomography myocardial perfusion imaging: a pilot for identification of hemodynamically significant coronary artery disease

Kuwahara

Tanabe

Kurata

et al. 2019

Cardiovasc Interv and Ther

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The purpose of this study was to evaluate the feasibility of the stenosis-related quantitative perfusion ratio (QPR) for detecting hemodynamically significant coronary artery disease (CAD). Twenty-seven patients were retrospectively enrolled. All patients underwent dynamic myocardial computed tomography perfusion (CTP) and coronary computed tomography angiography (CTA) before invasive coronary angiography (ICA) measuring the fractional flow reserve (FFR). Coronary lesions with FFR ≤ 0.8 were defined as hemodynamically significant CAD. The myocardial blood flow (MBF) was calculated using dynamic CTP data, and CT-QPR was calculated as the CT-MBF relative to the reference CT-MBF. The stenosis-related CT-MBF and QPR were calculated using Voronoi diagram-based myocardial segmentation from coronary CTA data. The relationships between FFR and stenosis-related CT-MBF or QPR and the diagnostic performance of the stenosis-related CT-MBF and QPR were evaluated. Of 81 vessels, FFR was measured in 39 vessels, and 20 vessels (51%) in 15 patients were diagnosed as hemodynamically significant CAD. The stenosis-related CT-QPR showed better correlation (r = 0.70, p < 0.05) than CT-MBF (r = 0.56, p < 0.05). Sensitivity and specificity for detecting hemodynamically significant CAD were 95% and 58% for CT-MBF, and 95% and 90% for CT-QPR, respectively. The area under the receiver operating characteristic curve for the CT-QPR was significantly higher than that for the CT-MBF (0.94 vs. 0.79; p < 0.05). The stenosis-related CT-QPR derived from dynamic myocardial CTP and coronary CTA showed a better correlation with FFR and a higher diagnostic performance for detecting hemodynamically significant CAD than the stenosis-related CT-MBF.

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Additional diagnostic value of new CT imaging techniques for the functional assessment of coronary artery disease: a meta-analysis

Cited by 23 publications

References 78 publications

Impact of machine-learning CT-derived fractional flow reserve for the diagnosis and management of coronary artery disease in the randomized CRESCENT trials

Impact of machine-learning CT-derived fractional flow reserve for the diagnosis and management of coronary artery disease in the randomized CRESCENT trials

Computed tomographic evaluation of myocardial ischemia

Coronary artery stenosis-related perfusion ratio using dynamic computed tomography myocardial perfusion imaging: a pilot for identification of hemodynamically significant coronary artery disease

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