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On-site assessment of computed tomography-derived fractional flow reserve in comparison with myocardial perfusion imaging and invasive fractional flow reserve

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Abstract

Myocardial perfusion imaging (MPI) using Single Photon Emission Computed Tomography has been established as a standard noninvasive tool for risk stratification of coronary artery disease (CAD). We evaluated the diagnostic performance of on-site workstation-based computed tomography-derived fractional flow reserve (CT-FFR) in comparison with MPI using invasive fractional flow reserve (invasive FFR) as a gold standard. We enrolled 97 patients with suspected CAD. Diagnostic performance of CT angiography (CTA), and CT-FFR was compared in 105 lesions of 97 patients. Invasive FFR ≤ 0.8 was detected in 38 (36%) lesions. Diagnostic performance of CT-FFR was improved compared with CTA (AUC 0.83 vs. 0.60, p < 0.0001). The lesions with both CTA and MPI findings (n = 47), invasive FFR ≤ 0.8 was detected in 19 (40.4) lesions. CT-FFR (AUC 0.81, 95% CI 0.72–0.94) significantly improved diagnostic performance compared with CTA-50% (AUC 0.59, p = 0.00019) and MPI (AUC 0.64, p = 0.0082). In lesions with ≥ 50% on CTA (n = 42), diagnostic accuracy of CT-FFR (AUC 0.81) was significantly superior to MPI (AUC 0.64, p = 0.0239). In conclusions, CT-FFR improved diagnostic accuracy to detect invasive FFR ≤ 0.8 compared with luminal stenosis on CTA and ischemia on MPI. Patients with ≥ 50% stenosis on CTA would be the candidates for CT-FFR.

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Authors and Affiliations

  1. Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Keiichi Miyajima, Sadako Motoyama, Masayoshi Sarai, Hideki Kawai, Yasuomi Nagahara, Wakaya Fujiwara, Takashi Muramatsu, Hiroyuki Naruse, Junnichi Ishii, Takeshi Kondo, Hideo Izawa & Yukio Ozaki

  2. Department of Radiology, Fujita Health University Hospital, Aichi, Japan

    Ryota Matsumoto

  3. Division of Medical Statistics, Fujita Health University, Aichi, Japan

    Hiroshi Takahashi

  4. Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, Japan

    Jagat Narula

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  1. Keiichi Miyajima
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Miyajima, K., Motoyama, S., Sarai, M. et al. On-site assessment of computed tomography-derived fractional flow reserve in comparison with myocardial perfusion imaging and invasive fractional flow reserve. Heart Vessels 35, 1331–1340 (2020). https://doi.org/10.1007/s00380-020-01606-z

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