On-site assessment of computed tomography-derived fractional flow reserve in comparison with myocardial perfusion imagin
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ORIGINAL ARTICLE
On‑site assessment of computed tomography‑derived fractional flow reserve in comparison with myocardial perfusion imaging and invasive fractional flow reserve Keiichi Miyajima1 · Sadako Motoyama1 · Masayoshi Sarai1 · Hideki Kawai1 · Yasuomi Nagahara1 · Ryota Matsumoto2 · Wakaya Fujiwara1 · Takashi Muramatsu1 · Hiroshi Takahashi3 · Hiroyuki Naruse1 · Junnichi Ishii1 · Takeshi Kondo1 · Jagat Narula4 · Hideo Izawa1 · Yukio Ozaki1 Received: 22 December 2019 / Accepted: 10 April 2020 © Springer Japan KK, part of Springer Nature 2020
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 were scanned at more than 2 heart beats. Patients who were scanned at systole or more than 2 beats at diastole were not included in this study, because these data were not eligible for CT-FFR analysis. The raw data of the CT scans were reconstructed using retrospective ECG-gated half reconstruction. Median (interquartile range: IQR) radiation exposure was 2.9 (2.1–4.0) mSv. The reconstructed image data of CT were transferred to an on-site computer workstation for post-processing: an optimal single phase data to ZIOSTATION System 1000 (Amin/ZIO, Japan) for evaluation of luminal stenosis and 4 volume data sets at 70, 80, 90, and 99% of R–R interval to sure-Cardio CTFFR (Research Version, W.I.P., Canon Medical Systems, Japan) for CT-FFR analysis.
Luminal stenosis on CTA Two cardiologists who were unaware of the patient’s clinical information, CT-FFR, MPI, and invasive FFR findings interpreted the luminal stenosis on CTA images by consensus based on visual estimation. Coronary arteries were divided into 15 segments based on the American Heart Association (AHA) classification, and the stenosis grade was evaluated in coronary arteries with a diameter of ≥ 2 mm. Stenosis was visually graded from 0 to 5 [0: absence of plaque and no luminal stenosis, 1: 50% stenosis on CTA (n = 91), CT-FFR ≤ 0.8 was detected in 42 lesions and invasive FFR ≤ 0.8 in 38 lesions
Heart and Vessels Table 3 Number of diseased vessels and the diagnostic performance Invasive FFR ≤ 0.8 [n (%)] True positive True negative False positive False negative AUC
0-VD (n = 18)
1-VD (n = 18)
2-VD (n = 8)
3-VD (n = 3)
CT-FFR
MPI
CT-FFR
MPI
CT-FFR
MPI
CT-FFR
MPI
0 (0) 0 16 2 0 –
0 17 1 0 –
10 (55.6) 7 5 3 3 0.66
2 8 0 8 0.60
6 (75) 5 1 1 1 0.67
2 2 0 4 0.67
3 (100) 3 0 0 0 –
2 0 1 0 –
AUC
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