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Diagnostic Performance of First-Pass Myocardial Perfusion Imaging without Stress with Computed Tomography (CT) Compared with Coronary CT Angiography Alone, with Fractional Flow Reserve as the Reference Standard.

Osawa K, Miyoshi T, Miki T, Koyama Y, Sato S, Kanazawa S, Ito H - PLoS ONE (2016)

Bottom Line: Invasive FFR <0.8 was considered as positive.First-pass CT-MPI without stress correctly reclassified 38% of CCTA false-positive vessels as true negative.This technique could complement CCTA for diagnosis of coronary artery disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.

ABSTRACT
Coronary computed tomography angiography (CCTA) in combination with first-pass CT myocardial perfusion imaging (MPI) has a better diagnostic performance than CCTA alone, compared with invasive coronary angiography as the reference standard. The aim of this study was to investigate the additional diagnostic value of first-pass CT-MPI without stress for detecting hemodynamic significance of coronary stenosis, compared with invasive fractional flow reserve (FFR). We recruited 53 patients with suspected coronary artery disease undergoing both CCTA and first-pass CT-MPI without stress and invasive FFR, and 75 vessels were analyzed. We used the same raw data for CCTA and CT-MPI. First-pass CT-MPI was reconstructed by examining the diastolic signal densities as a bull's eye map. Invasive FFR <0.8 was considered as positive. On per-vessel analysis, the area under the receiver operating characteristic curve for CCTA plus first-pass CT-MPI and CCTA alone was 0.81 (0.73-0.90) and 0.70 (0.61-0.81), respectively (P = 0.036). CCTA plus first-pass CT-MPI without stress showed 0.73 sensitivity, 0.74 specificity, 0.53 positive predictive value, and 0.87 negative predictive value for detecting hemodynamically significant coronary stenosis. First-pass CT-MPI without stress correctly reclassified 38% of CCTA false-positive vessels as true negative. First-pass CT-MPI without stress combined with CCTA demonstrated excellent diagnostic accuracy, compared with invasive FFR as the reference standard. This technique could complement CCTA for diagnosis of coronary artery disease.

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Reclassification criteria.Before CT-MPI analysis, nonevaluable with CCTA was defined as positive for stenosis using the following criteria: those with no vessel wall definition owing to marked motion artifacts or heavy calcification that precluded acquisition of diagnostic information.
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pone.0149170.g001: Reclassification criteria.Before CT-MPI analysis, nonevaluable with CCTA was defined as positive for stenosis using the following criteria: those with no vessel wall definition owing to marked motion artifacts or heavy calcification that precluded acquisition of diagnostic information.

Mentions: With FFR as the reference standard, the diagnostic accuracy of CCTA and CCTA plus CT-MPI without stress was expressed in terms of accuracy, sensitivity, specificity, positive predictive value and negative predictive value for the detection of vascular territories with significant obstructive coronary artery stenosis. Diagnostic performance was calculated on a vessel basis. CCTA diagnosis was reclassified according to CT-MPI without stress. After CT-MPI analysis, nonevaluable vessels with CCTA were considered positive for stenosis only if they corresponded to a CT-MPI defect in the same vascular distribution. Moderate stenosis (50–70%) on CCTA were reclassified as negative if CT-MPI showed no defect in the same distribution. Diffuse stenosis with luminal narrowing of 30–50% on CCTA was reclassified as positive if CT-MPI showed a defect in the same distribution. CCTA stenosis was not reclassified when no stenosis <50% or >70% was apparent on CCTA (Fig 1). The area under the receiver operating characteristic curve (C statistic) was calculated for all diagnostic testing strategies for which a reference standard was available. A value of P < 0.05 was considered statistically significant. The area under the receiver operating characteristic curve was compared using the ROCCOMP command (Stata version 10; Stata Corp., College Station, TX, USA).


Diagnostic Performance of First-Pass Myocardial Perfusion Imaging without Stress with Computed Tomography (CT) Compared with Coronary CT Angiography Alone, with Fractional Flow Reserve as the Reference Standard.

Osawa K, Miyoshi T, Miki T, Koyama Y, Sato S, Kanazawa S, Ito H - PLoS ONE (2016)

Reclassification criteria.Before CT-MPI analysis, nonevaluable with CCTA was defined as positive for stenosis using the following criteria: those with no vessel wall definition owing to marked motion artifacts or heavy calcification that precluded acquisition of diagnostic information.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4764509&req=5

pone.0149170.g001: Reclassification criteria.Before CT-MPI analysis, nonevaluable with CCTA was defined as positive for stenosis using the following criteria: those with no vessel wall definition owing to marked motion artifacts or heavy calcification that precluded acquisition of diagnostic information.
Mentions: With FFR as the reference standard, the diagnostic accuracy of CCTA and CCTA plus CT-MPI without stress was expressed in terms of accuracy, sensitivity, specificity, positive predictive value and negative predictive value for the detection of vascular territories with significant obstructive coronary artery stenosis. Diagnostic performance was calculated on a vessel basis. CCTA diagnosis was reclassified according to CT-MPI without stress. After CT-MPI analysis, nonevaluable vessels with CCTA were considered positive for stenosis only if they corresponded to a CT-MPI defect in the same vascular distribution. Moderate stenosis (50–70%) on CCTA were reclassified as negative if CT-MPI showed no defect in the same distribution. Diffuse stenosis with luminal narrowing of 30–50% on CCTA was reclassified as positive if CT-MPI showed a defect in the same distribution. CCTA stenosis was not reclassified when no stenosis <50% or >70% was apparent on CCTA (Fig 1). The area under the receiver operating characteristic curve (C statistic) was calculated for all diagnostic testing strategies for which a reference standard was available. A value of P < 0.05 was considered statistically significant. The area under the receiver operating characteristic curve was compared using the ROCCOMP command (Stata version 10; Stata Corp., College Station, TX, USA).

Bottom Line: Invasive FFR <0.8 was considered as positive.First-pass CT-MPI without stress correctly reclassified 38% of CCTA false-positive vessels as true negative.This technique could complement CCTA for diagnosis of coronary artery disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.

ABSTRACT
Coronary computed tomography angiography (CCTA) in combination with first-pass CT myocardial perfusion imaging (MPI) has a better diagnostic performance than CCTA alone, compared with invasive coronary angiography as the reference standard. The aim of this study was to investigate the additional diagnostic value of first-pass CT-MPI without stress for detecting hemodynamic significance of coronary stenosis, compared with invasive fractional flow reserve (FFR). We recruited 53 patients with suspected coronary artery disease undergoing both CCTA and first-pass CT-MPI without stress and invasive FFR, and 75 vessels were analyzed. We used the same raw data for CCTA and CT-MPI. First-pass CT-MPI was reconstructed by examining the diastolic signal densities as a bull's eye map. Invasive FFR <0.8 was considered as positive. On per-vessel analysis, the area under the receiver operating characteristic curve for CCTA plus first-pass CT-MPI and CCTA alone was 0.81 (0.73-0.90) and 0.70 (0.61-0.81), respectively (P = 0.036). CCTA plus first-pass CT-MPI without stress showed 0.73 sensitivity, 0.74 specificity, 0.53 positive predictive value, and 0.87 negative predictive value for detecting hemodynamically significant coronary stenosis. First-pass CT-MPI without stress correctly reclassified 38% of CCTA false-positive vessels as true negative. First-pass CT-MPI without stress combined with CCTA demonstrated excellent diagnostic accuracy, compared with invasive FFR as the reference standard. This technique could complement CCTA for diagnosis of coronary artery disease.

Show MeSH
Related in: MedlinePlus