期刊
JACC-CARDIOVASCULAR IMAGING
卷 13, 期 4, 页码 994-1004出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcmg.2019.06.028
关键词
cardiac magnetic resonance stress perfusion imaging; coronary computed tomography angiography-derived fractional flow reserve; stable angina; revascularization
资金
- Danish Heart Foundation [15-R99-A5837-22920]
- Health Research Fund of Central Denmark Region
- National Institute for Health Research Biomedical Research Centre at Barts
- Abbott
- Boston Scientific
OBJECTIVES This study was designed to compare head-to-head fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) and cardiac magnetic resonance (CMR) stress perfusion imaging for prediction of standard-of-care-guided coronary revascularization in patients with stable chest pain and obstructive coronary artery disease by coronary CTA. BACKGROUND FFRCT is a novel modality for noninvasive functional testing. The clinical utility of FFRCT compared to CMR stress perfusion imaging in symptomatic patients with coronary artery disease is unknown. METHODS Prospective study of patients (n = 110) with stable angina pectoris and 1 or more coronary stenosis >= 50% by coronary CTA. All patients underwent invasive coronary angiography. Revascularization was FFR-guided in stenoses ranging from 30% to 90%. FFRCT <= 0.80 in 1 or more coronary artery or a reversible perfusion defect (>= 2 segments) by CMR categorized patients with ischemia. FFRCT and CMR were analyzed by core laboratories blinded for patient management. RESULTS A total of 38 patients (35%) underwent revascularization. Per-patient diagnostic performance for identifying standard-of-care-guided revascularization, (95% confidence interval) yielded a sensitivity of 97% (86% to 100%) for FFRCT versus 47% (31% to 64%) for CMR, p < 0.001; corresponding specificity was 42% (30% to 54%) versus 88% (78% to 94%), p < 0.001; negative predictive value of 97% (91% to 100%) versus 76% (67% to 85%), p < 0.05; positive predictive value of 47% (36% to 58%) versus 67% (49% to 84%), p < 0.05; and accuracy of 61% (51% to 70%) versus 74% (64% to 82%), p > 0.05, respectively. CONCLUSIONS In patients with stable chest pain referred to invasive coronary angiography based on coronary CTA, FFRCT and CMR yielded similar overall diagnostic accuracy. Sensitivity for prediction of revascularization was highest for FFRCT, whereas specificity was highest for CMR. (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据