Diagnostic performance of intracoronary gradient-based methods by coronary computed tomography angiography for the evaluation of physiologically significant coronary artery stenoses: a validation study with fractional flow reserve

Choi, Jin‐Ho; Koo, Bon‐Kwon; Yoon, Yeonyee E.; Min, James K.; Song, Young-Min; Hahn, Joo‐Yong; Choi, Seung‐Hyuk; Gwon, Hyeon‐Cheol; Choe, Yeon Hyeon

doi:10.1093/ehjci/jes130

Cited by 79 publications

(63 citation statements)

References 24 publications

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“…In addition, the diagnostic performance of TAG was lower but not statistically different from that of CCTA stenosis alone (AUC: 0.63 vs. 0.73, p = 0.217) [9]. Choi also demonstrated similar results showing lower diagnostic performance of TAG than that of CCTA stenosis (AUC: 0.696 vs. 0.726) among 63 patients undergoing 64-slice CCTA [22]. These findings are in line with our results demonstrating only a modest diagnostic performance of TAG.…”

Section: Discussionmentioning

confidence: 95%

“…TAG is a novel method developed to assess the hemodynamic significance of CAD and is calculated using a linear regression model of luminal contrast attenuations in a coronary vessel obtained by manual or semi-automated techniques [9,10,[19][20][21][22]. To date, several studies have examined the relation of TAG to invasive FFR and have shown a variety in the diagnostic accuracy of TAG in predicting lesion-specific ischemia by invasive FFR \0.80.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic performance of transluminal attenuation gradient and fractional flow reserve by coronary computed tomographic angiography (FFRCT) compared to invasive FFR: a sub-group analysis from the DISCOVER-FLOW and DeFACTO studies

Nakanishi

Matsumoto

Alani

et al. 2015

Int J Cardiovasc Imaging

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Although coronary computed tomographic angiography (CCTA) has been a robust diagnostic tool to identify anatomical significance of coronary artery disease (CAD), the utility of CCTA to assess hemodynamic significance of CAD remains unclear. We investigated the diagnostic performance of transluminal attenuation gradient (TAG) and fractional flow reserve derived from CCTA (FFR CT ) to predict lesion-specific ischemia by invasive FFR. We identified 103 patients with suspected or known CAD enrolled from the DISCOVER-FLOW and DeFACTO studies who underwent invasive coronary angiography with FFR and high quality C64-slice CCTA. Diagnostic performance for predicting abnormal invasive FFR (B0.80) was assessed for TAG [B-1.1 HU/mm by the area under the curve (AUC) by receiver-operating characteristic curve analysis (ROC)], FFR CT (B0.80), and CCTA stenosis (C50 %). On a per-vessel analysis (n = 146), 52 vessels (35.6 %) had ischemia by invasive FFR. The sensitivity, specificity, positive predictive value and negative predictive value were 53.8, 45.7, 35.4, 64.2 % for TAG, 82.7, 74.5, 64.2, 88.6 % for FFR CT , 84.6, 39.4, 43.6, 82 . These results remained consistent regardless of the number of CCTA slices. FFR CT allows identification of lesion-specific ischemia using invasive FFR as a reference standard with greater diagnostic accuracy than TAG, CCTA stenosis, or the combination of the two.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of transluminal attenuation gradient and fractional flow reserve by coronary computed tomographic angiography (FFRCT) compared to invasive FFR: a sub-group analysis from the DISCOVER-FLOW and DeFACTO studies

Nakanishi

Matsumoto

Alani

et al. 2015

Int J Cardiovasc Imaging

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“…66 In a second study of 97 vessels in 63 patients with invasive FFR, the sensitivity, specificity, PPV, and NPV of TAG were 48%, 91%, 79%, and 71%, respectively; TAG was additive to CTA alone (c-statistic increased from 0.726-0.809, P=0.025). 67 For CCO, the corresponding values were 65%, 61%, 54%, and 71%, and it did not significantly increase the c-statistic of CTA (0.726 versus 0.784, P=0.09). Comparison of TAG with CTA and FFRCT was performed in 53 patients and 82 vessels from the DISCOVER-FLOW trial; TAG sensitivity was 38% versus 72% for CTA >70% DS and 81% for FFRCT.…”

Section: Ct Myocardial Perfusion Imagingmentioning

confidence: 84%

Fractional Flow Reserve and Coronary Computed Tomographic Angiography

Hecht

Narula

Fearon

2016

Circulation Research

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Obstructive coronary artery disease (CAD) produces symptoms and increases the risk of adverse cardiac outcomes. However, determining whether a particular coronary stenosis is responsible for causing myocardial ischemia can be challenging, even with invasive coronary angiography (ICA). how should high-risk plaque be incorporated into treatment decisions? (7) how will CT-FFR influence other functional imaging test utilization, and what will be the effect on the practice of cardiology? (8) will a workstationbased CT-FFR be mandatory? Rapid progress to date suggests that CTA-based lesion-specific ischemia will be the gatekeeper to the cardiac catheterization laboratory and will transform the world of intervention.

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“…[14][15][16] TAG demonstrated the feasibility for noninvasive assessment of hemodynamically significant coronary arterial stenosis and flow. [17][18][19][20] We hypothesized that the concept of intraluminal contrast media kinetics could also be applied to totally occluded vessel supplied by collateral flow. We measured TAG of totally occluded coronary arteries and validated it with the functional extent and direction of collateral flow determined by invasive coronary angiography.…”

Section: Clinical Perspective On P 490mentioning

confidence: 99%

“…[17][18][19] In brief, cross-sectional images perpendicular to the vessel centerline were reconstructed for each major coronary artery. Luminal cross-sectional area (in mm 2 ) and radiological attenuation (in HU) were measured at 5-mm intervals from the ostium (TAG of an entire artery, TAG all ) or just distal to CTO segment (TAG of a distal vessel, TAG distal ) where the vessel cross-sectional area fell <2.0 mm 2 .…”

Section: Transluminal Attenuation Gradientmentioning

confidence: 99%

Noninvasive Evaluation of Coronary Collateral Arterial Flow by Coronary Computed Tomographic Angiography

Choi

Kim

et al. 2014

Circ: Cardiovascular Imaging

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Background-Coronary collateral flow is an alternative source of myocardial perfusion in patients with totally occluded coronary arteries. Clinical evaluation of collateral flow has been limited by the need of invasive measurements. We investigated whether noninvasive coronary computed tomographic angiography can evaluate the angiographic extent of coronary collateral flow. Methods and Results-We enrolled 325 coronary computed tomographic angiography cases with angiographically confirmed chronic total occlusion (median age, 63 years; men 83%). Transluminal attenuation gradient (TAG), which reflects the kinetics of contrast media in coronary artery, of an entire artery as well as of a distal vessel was assessed to evaluate the flow in entire vessel and distal vessel. TAGs were validated against visually assessed angiographic collateral connection and Rentrop grading. TAG of an entire artery increased consistently according to the angiographic extent of collateral flow (P<0.001). Well-developed collaterals, defined by highest collateral connection and Rentrop grades (n=103), could be predicted by TAG of an entire artery (cutoff, ≥−7.6 Hounsfield units/10 mm; c-statistics, 0.72; sensitivity, 65%; specificity, 73%; positive predictive value, 52%; negative predictive value, 82%). TAG of a distal vessel could discriminate the antegrade (n=143) and retrograde (n=182) flows in distal artery (cutoff, 0.0 Hounsfield unit/10 mm; c-statistics, 0.88; sensitivity, 78%; specificity, 85%; positive predictive value, 87%; negative predictive value, 75%). Conclusions-TAG,

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Diagnostic performance of intracoronary gradient-based methods by coronary computed tomography angiography for the evaluation of physiologically significant coronary artery stenoses: a validation study with fractional flow reserve

Abstract: Intracoronary attenuation-based CCTA analyses, TAG and CCO, showed moderate correlation with physiological coronary artery stenosis. The incremental value of TAG or CCO to the evaluation of haemodynamically stenosis by CCTA seemed to be limited.

Cited by 79 publications

References 24 publications

Diagnostic performance of transluminal attenuation gradient and fractional flow reserve by coronary computed tomographic angiography (FFRCT) compared to invasive FFR: a sub-group analysis from the DISCOVER-FLOW and DeFACTO studies

Diagnostic performance of transluminal attenuation gradient and fractional flow reserve by coronary computed tomographic angiography (FFRCT) compared to invasive FFR: a sub-group analysis from the DISCOVER-FLOW and DeFACTO studies

Fractional Flow Reserve and Coronary Computed Tomographic Angiography

Noninvasive Evaluation of Coronary Collateral Arterial Flow by Coronary Computed Tomographic Angiography

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