Coronary Artery Stenosis Evaluation by Angiography-Derived FFR: Validation by Positron Emission Tomography and Invasive Thermodilution

Jelmer Westra; Laust Dupont Rasmussen; Ashkan Eftekhari; Simon Winther; Salma Raghad Karim; Jane Kirk Johansen; Osama Hammid; Hanne Maare Søndergaard; June Anita Ejlersen; Lars C. Gormsen; Lone Juul Hune Mogensen; Morten Bøttcher; Niels Ramsing Holm; Evald Høj Christiansen

doi:10.1016/j.jcmg.2023.02.008

Coronary Artery Stenosis Evaluation by Angiography-Derived FFR: Validation by Positron Emission Tomography and Invasive Thermodilution

Jelmer Westra^*, Laust Dupont Rasmussen, Ashkan Eftekhari, Simon Winther, Salma Raghad Karim, Jane Kirk Johansen, Osama Hammid, Hanne Maare Søndergaard, June Anita Ejlersen, Lars C. Gormsen, Lone Juul Hune Mogensen, Morten Bøttcher, Niels Ramsing Holm, Evald Høj Christiansen

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

6 Citationer (Scopus)

Abstract

BACKGROUND: Fractional flow reserve (FFR) derived from invasive coronary angiography (QFR) is promising for evaluation of intermediate coronary artery stenosis.

OBJECTIVES: The authors aimed to compare the diagnostic performance of QFR and the guideline-recommended invasive FFR using 82Rubidium positron emission tomography ( 82Rb-PET) myocardial perfusion imaging as reference standard.

METHODS: This is a prospective, observational study of symptomatic patients with suspected obstructive coronary artery disease on coronary computed tomography angiography (≥50% diameter stenosis in ≥1 vessel). All patients were referred to 82Rb-PET and invasive coronary angiography with FFR and QFR assessment of all intermediate (30%-90% diameter stenosis) stenoses. Main analyses included a comparison of the ability of QFR and FFR to identify reduced myocardial blood flow (<2 mL/g/min) during vasodilation and/or relative perfusion abnormalities (summed stress score ≥4 in ≥2 adjacent segments).

RESULTS: A total of 250 patients (320 vessels) with indication for invasive physiological assessment were included. The continuous relationship of 82Rb-PET stress myocardial blood flow per 0.10 increase in FFR was +0.14 mL/g/min (95% CI: 0.07-0.21 mL/g/min) and +0.08 mL/g/min (95% CI: 0.02-0.14 mL/g/min) per 0.10 QFR increase. Using 82Rb-PET as reference, QFR and FFR had similar diagnostic performance on both a per-patient level (accuracy: 73%; 95% CI: 67-79; vs accuracy: 71%; 95% CI: 64-78) and per-vessel level (accuracy: 70%; 95% CI: 64-75; vs accuracy: 68%; 95% CI: 62-73). The per-vessel feasibility was 84% (95% CI: 80-88) for QFR and 88% (95% CI: 85-92) for FFR by intention-to-diagnose analysis.

CONCLUSIONS: With 82Rb-PET as reference modality, the wire-free QFR solution showed similar diagnostic accuracy as invasive FFR in evaluation of intermediate coronary stenosis. (DAN-NICAD - Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease; NCT02264717).

Originalsprog	Engelsk
Tidsskrift	JACC: Cardiovascular Imaging
Vol/bind	16
Nummer	10
Sider (fra-til)	1321-1331
Antal sider	11
ISSN	1936-878X
DOI	https://doi.org/10.1016/j.jcmg.2023.02.008
Status	Udgivet - okt. 2023

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Westra, J., Rasmussen, L. D., Eftekhari, A., Winther, S., Karim, S. R., Johansen, J. K., Hammid, O., Søndergaard, H. M., Ejlersen, J. A., Gormsen, L. C., Mogensen, L. J. H., Bøttcher, M., Holm, N. R., & Christiansen, E. H. (2023). Coronary Artery Stenosis Evaluation by Angiography-Derived FFR: Validation by Positron Emission Tomography and Invasive Thermodilution. JACC: Cardiovascular Imaging, 16(10), 1321-1331. https://doi.org/10.1016/j.jcmg.2023.02.008

@article{151f7e56fae647b4851f584f06abf0f8,

title = "Coronary Artery Stenosis Evaluation by Angiography-Derived FFR: Validation by Positron Emission Tomography and Invasive Thermodilution",

abstract = "BACKGROUND: Fractional flow reserve (FFR) derived from invasive coronary angiography (QFR) is promising for evaluation of intermediate coronary artery stenosis.OBJECTIVES: The authors aimed to compare the diagnostic performance of QFR and the guideline-recommended invasive FFR using 82Rubidium positron emission tomography ( 82Rb-PET) myocardial perfusion imaging as reference standard. METHODS: This is a prospective, observational study of symptomatic patients with suspected obstructive coronary artery disease on coronary computed tomography angiography (≥50% diameter stenosis in ≥1 vessel). All patients were referred to 82Rb-PET and invasive coronary angiography with FFR and QFR assessment of all intermediate (30%-90% diameter stenosis) stenoses. Main analyses included a comparison of the ability of QFR and FFR to identify reduced myocardial blood flow (<2 mL/g/min) during vasodilation and/or relative perfusion abnormalities (summed stress score ≥4 in ≥2 adjacent segments). RESULTS: A total of 250 patients (320 vessels) with indication for invasive physiological assessment were included. The continuous relationship of 82Rb-PET stress myocardial blood flow per 0.10 increase in FFR was +0.14 mL/g/min (95% CI: 0.07-0.21 mL/g/min) and +0.08 mL/g/min (95% CI: 0.02-0.14 mL/g/min) per 0.10 QFR increase. Using 82Rb-PET as reference, QFR and FFR had similar diagnostic performance on both a per-patient level (accuracy: 73%; 95% CI: 67-79; vs accuracy: 71%; 95% CI: 64-78) and per-vessel level (accuracy: 70%; 95% CI: 64-75; vs accuracy: 68%; 95% CI: 62-73). The per-vessel feasibility was 84% (95% CI: 80-88) for QFR and 88% (95% CI: 85-92) for FFR by intention-to-diagnose analysis. CONCLUSIONS: With 82Rb-PET as reference modality, the wire-free QFR solution showed similar diagnostic accuracy as invasive FFR in evaluation of intermediate coronary stenosis. (DAN-NICAD - Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease; NCT02264717). ",

keywords = "coronary physiology, myocardial perfusion imaging, quantitative coronary angiography",

author = "Jelmer Westra and Rasmussen, {Laust Dupont} and Ashkan Eftekhari and Simon Winther and Karim, {Salma Raghad} and Johansen, {Jane Kirk} and Osama Hammid and S{\o}ndergaard, {Hanne Maare} and Ejlersen, {June Anita} and Gormsen, {Lars C.} and Mogensen, {Lone Juul Hune} and Morten B{\o}ttcher and Holm, {Niels Ramsing} and Christiansen, {Evald H{\o}j}",

note = "Publisher Copyright: {\textcopyright} 2023 American College of Cardiology Foundation",

year = "2023",

month = oct,

doi = "10.1016/j.jcmg.2023.02.008",

language = "English",

volume = "16",

pages = "1321--1331",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "10",

}

Westra, J , Rasmussen, LD, Eftekhari, A, Winther, S , Karim, SR, Johansen, JK, Hammid, O, Søndergaard, HM, Ejlersen, JA, Gormsen, LC , Mogensen, LJH , Bøttcher, M , Holm, NR & Christiansen, EH 2023, 'Coronary Artery Stenosis Evaluation by Angiography-Derived FFR: Validation by Positron Emission Tomography and Invasive Thermodilution', JACC: Cardiovascular Imaging, bind 16, nr. 10, s. 1321-1331. https://doi.org/10.1016/j.jcmg.2023.02.008

Coronary Artery Stenosis Evaluation by Angiography-Derived FFR: Validation by Positron Emission Tomography and Invasive Thermodilution. / Westra, Jelmer ; Rasmussen, Laust Dupont; Eftekhari, Ashkan et al.
I: JACC: Cardiovascular Imaging, Bind 16, Nr. 10, 10.2023, s. 1321-1331.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Coronary Artery Stenosis Evaluation by Angiography-Derived FFR

T2 - Validation by Positron Emission Tomography and Invasive Thermodilution

AU - Westra, Jelmer

AU - Rasmussen, Laust Dupont

AU - Eftekhari, Ashkan

AU - Winther, Simon

AU - Karim, Salma Raghad

AU - Johansen, Jane Kirk

AU - Hammid, Osama

AU - Søndergaard, Hanne Maare

AU - Ejlersen, June Anita

AU - Gormsen, Lars C.

AU - Mogensen, Lone Juul Hune

AU - Bøttcher, Morten

AU - Holm, Niels Ramsing

AU - Christiansen, Evald Høj

PY - 2023/10

Y1 - 2023/10

N2 - BACKGROUND: Fractional flow reserve (FFR) derived from invasive coronary angiography (QFR) is promising for evaluation of intermediate coronary artery stenosis.OBJECTIVES: The authors aimed to compare the diagnostic performance of QFR and the guideline-recommended invasive FFR using 82Rubidium positron emission tomography ( 82Rb-PET) myocardial perfusion imaging as reference standard. METHODS: This is a prospective, observational study of symptomatic patients with suspected obstructive coronary artery disease on coronary computed tomography angiography (≥50% diameter stenosis in ≥1 vessel). All patients were referred to 82Rb-PET and invasive coronary angiography with FFR and QFR assessment of all intermediate (30%-90% diameter stenosis) stenoses. Main analyses included a comparison of the ability of QFR and FFR to identify reduced myocardial blood flow (<2 mL/g/min) during vasodilation and/or relative perfusion abnormalities (summed stress score ≥4 in ≥2 adjacent segments). RESULTS: A total of 250 patients (320 vessels) with indication for invasive physiological assessment were included. The continuous relationship of 82Rb-PET stress myocardial blood flow per 0.10 increase in FFR was +0.14 mL/g/min (95% CI: 0.07-0.21 mL/g/min) and +0.08 mL/g/min (95% CI: 0.02-0.14 mL/g/min) per 0.10 QFR increase. Using 82Rb-PET as reference, QFR and FFR had similar diagnostic performance on both a per-patient level (accuracy: 73%; 95% CI: 67-79; vs accuracy: 71%; 95% CI: 64-78) and per-vessel level (accuracy: 70%; 95% CI: 64-75; vs accuracy: 68%; 95% CI: 62-73). The per-vessel feasibility was 84% (95% CI: 80-88) for QFR and 88% (95% CI: 85-92) for FFR by intention-to-diagnose analysis. CONCLUSIONS: With 82Rb-PET as reference modality, the wire-free QFR solution showed similar diagnostic accuracy as invasive FFR in evaluation of intermediate coronary stenosis. (DAN-NICAD - Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease; NCT02264717).

AB - BACKGROUND: Fractional flow reserve (FFR) derived from invasive coronary angiography (QFR) is promising for evaluation of intermediate coronary artery stenosis.OBJECTIVES: The authors aimed to compare the diagnostic performance of QFR and the guideline-recommended invasive FFR using 82Rubidium positron emission tomography ( 82Rb-PET) myocardial perfusion imaging as reference standard. METHODS: This is a prospective, observational study of symptomatic patients with suspected obstructive coronary artery disease on coronary computed tomography angiography (≥50% diameter stenosis in ≥1 vessel). All patients were referred to 82Rb-PET and invasive coronary angiography with FFR and QFR assessment of all intermediate (30%-90% diameter stenosis) stenoses. Main analyses included a comparison of the ability of QFR and FFR to identify reduced myocardial blood flow (<2 mL/g/min) during vasodilation and/or relative perfusion abnormalities (summed stress score ≥4 in ≥2 adjacent segments). RESULTS: A total of 250 patients (320 vessels) with indication for invasive physiological assessment were included. The continuous relationship of 82Rb-PET stress myocardial blood flow per 0.10 increase in FFR was +0.14 mL/g/min (95% CI: 0.07-0.21 mL/g/min) and +0.08 mL/g/min (95% CI: 0.02-0.14 mL/g/min) per 0.10 QFR increase. Using 82Rb-PET as reference, QFR and FFR had similar diagnostic performance on both a per-patient level (accuracy: 73%; 95% CI: 67-79; vs accuracy: 71%; 95% CI: 64-78) and per-vessel level (accuracy: 70%; 95% CI: 64-75; vs accuracy: 68%; 95% CI: 62-73). The per-vessel feasibility was 84% (95% CI: 80-88) for QFR and 88% (95% CI: 85-92) for FFR by intention-to-diagnose analysis. CONCLUSIONS: With 82Rb-PET as reference modality, the wire-free QFR solution showed similar diagnostic accuracy as invasive FFR in evaluation of intermediate coronary stenosis. (DAN-NICAD - Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease; NCT02264717).

KW - coronary physiology

KW - myocardial perfusion imaging

KW - quantitative coronary angiography

UR - http://www.scopus.com/inward/record.url?scp=85153960851&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2023.02.008

DO - 10.1016/j.jcmg.2023.02.008

M3 - Journal article

C2 - 37052562

SN - 1936-878X

VL - 16

SP - 1321

EP - 1331

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 10

ER -

Coronary Artery Stenosis Evaluation by Angiography-Derived FFR: Validation by Positron Emission Tomography and Invasive Thermodilution

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