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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

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Abstract

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 (FFRCT) 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 ≥64-slice CCTA. Diagnostic performance for predicting abnormal invasive FFR (≤0.80) was assessed for TAG [≤−1.1 HU/mm by the area under the curve (AUC) by receiver-operating characteristic curve analysis (ROC)], FFRCT (≤0.80), and CCTA stenosis (≥50 %). 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 FFRCT, 84.6, 39.4, 43.6, 82.2 % for CCTA stenosis, respectively. The AUC by ROC curve analysis for FFRCT (0.79) demonstrated greater discrimination of hemodynamic ischemia compared to TAG (0.50, p < 0.0001 vs. FFRCT), CCTA stenosis (0.62, p = 0.0004 vs. FFRCT) and the combination of the two (0.63, p = 0.004 vs. FFRCT). These results remained consistent regardless of the number of CCTA slices. FFRCT 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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Abbreviations

CCTA:

Coronary computed tomographic angiography

CAD:

Coronary artery disease

FFR:

Fractional flow reserve

TAG:

Transluminal attenuation gradient

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Acknowledgments

Dr. Matthew Budoff is a consultant for General Electric. Dr. James K. Min has served on the medical advisory boards of GE Healthcare, Arineta, Astra Zeneca, and Bristol-Myers Squibb; Speakers’ Bureau of GE Healthcare; and received research support from GE Healthcare, Vital Images, and Phillips Healthcare. Dr. Min serves as a consultant to Astra Zeneca and HeartFlow.; the other authors have no conflict of interest. This study is funded in part by HeartFlow Inc. The authors thank Vivek Bhatia, Souma Sengputa, Michael Fahmy, Jeby Abraham, Lucas Cespedes, and Christopher Dailing for contributions to this study.

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Authors and Affiliations

  1. Los Angeles Biomedical Research Center at Harbor UCLA Medical Center, Torrance, CA, USA

    Rine Nakanishi, Suguru Matsumoto, Anas Alani, Dong Li & Matthew J. Budoff

  2. Leiden University Medical Center, Leiden, The Netherland

    Pieter H. Kitslaar & Alexander Broersen

  3. Department of Medicine, Seoul National University Hospital, Seoul, South Korea

    Bon-Kwon Koo

  4. Department of Radiology, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA

    James K. Min

  5. Department of Cardiology, Harbor UCLA Medical Center, Los Angeles, CA, USA

    Matthew J. Budoff

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  1. Rine Nakanishi
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  2. Suguru Matsumoto
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Correspondence to Matthew J. Budoff.

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Nakanishi, R., Matsumoto, S., Alani, A. et al. 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. Int J Cardiovasc Imaging 31, 1251–1259 (2015). https://doi.org/10.1007/s10554-015-0666-2

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  • DOI: https://doi.org/10.1007/s10554-015-0666-2

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