Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography

Jonathan N. Dahl; Laust D. Rasmussen; Daixin Ding; Shengxian Tu; Jelmer Westra; William Wijns; Evald Høj Christiansen; Ashkan Eftekhari; Guanyu Li; Simon Winther; Morten Bøttcher

doi:10.1016/j.jcct.2024.01.004

Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography

Jonathan N. Dahl^*, Laust D. Rasmussen, Daixin Ding, Shengxian Tu, Jelmer Westra, William Wijns, Evald Høj Christiansen, Ashkan Eftekhari, Guanyu Li, Simon Winther, Morten Bøttcher

^*Corresponding author af dette arbejde

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

2 Citationer (Scopus)

Abstract

Background: Coronary computed tomography angiography (CCTA)-derived quantitative flow ratio (CT-QFR) is an on-site non-invasive technique estimating invasive fractional flow reserve (FFR). This study assesses the diagnostic performance of using most distal CT-QFR versus lesion-specific CT-QFR approach for identifying hemodynamically obstructive coronary artery disease (CAD). Methods: Prospectively enrolled de novo chest pain patients (n = 445) with ≥50 % visual diameter stenosis on CCTA were referred for invasive evaluation. On-site CT-QFR was analyzed post-hoc blinded to angiographic data and obtained as both most distal (MD-QFR) and lesion-specific CT-QFR (LS-QFR). Abnormal CT-QFR was defined as ≤0.80. Hemodynamically obstructive CAD was defined as invasive FFR ≤0.80 or ≥70 % diameter stenosis by 3D-quantitative coronary angiography. Results: In total 404/445 patients had paired CT-QFR and invasive analyses of whom 149/404 (37 %) had hemodynamically obstructive CAD. MD-QFR and LS-QFR classified 188 (47 %) and 165 (41 %) patients as abnormal, respectively. Areas under the receiver-operating characteristic curve for MD-QFR was 0.83 vs. 0.85 for LS-QFR, p = 0.01. Sensitivities for MD-QFR and LS-QFR were 80 % (95%CI: 73–86) vs. 77 % (95%CI: 69–83), p = 0.03, respectively, and specificities were 73 % (95%CI: 67–78) vs. 80 % (95%CI: 75–85), p < 0.01, respectively. Positive predictive values for MD-QFR and LS-QFR were 63 % vs. 69 %, p < 0.01, respectively, and negative predictive values for MD-QFR and LS-QFR were 86 % vs. 85 %, p = 0.39, respectively). Conclusion: Using a lesion-specific CT-QFR approach has superior discrimination of hemodynamically obstructive CAD compared to a most distal CT-QFR approach. CT-QFR identified most cases of hemodynamically obstructive CAD while a normal CT-QFR excluded hemodynamically obstructive CAD in the majority of patients.

Originalsprog	Engelsk
Tidsskrift	Journal of Cardiovascular Computed Tomography
Vol/bind	18
Nummer	2
Sider (fra-til)	162-169
Antal sider	8
ISSN	1934-5925
DOI	https://doi.org/10.1016/j.jcct.2024.01.004
Status	Udgivet - mar. 2024

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10.1016/j.jcct.2024.01.004Licens: CC BY

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Dahl, J. N., Rasmussen, L. D., Ding, D., Tu, S., Westra, J., Wijns, W., Christiansen, E. H., Eftekhari, A., Li, G., Winther, S., & Bøttcher, M. (2024). Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography. Journal of Cardiovascular Computed Tomography, 18(2), 162-169. https://doi.org/10.1016/j.jcct.2024.01.004

@article{9893808838874e8b80063151dd645f05,

title = "Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography",

abstract = "Background: Coronary computed tomography angiography (CCTA)-derived quantitative flow ratio (CT-QFR) is an on-site non-invasive technique estimating invasive fractional flow reserve (FFR). This study assesses the diagnostic performance of using most distal CT-QFR versus lesion-specific CT-QFR approach for identifying hemodynamically obstructive coronary artery disease (CAD). Methods: Prospectively enrolled de novo chest pain patients (n = 445) with ≥50 % visual diameter stenosis on CCTA were referred for invasive evaluation. On-site CT-QFR was analyzed post-hoc blinded to angiographic data and obtained as both most distal (MD-QFR) and lesion-specific CT-QFR (LS-QFR). Abnormal CT-QFR was defined as ≤0.80. Hemodynamically obstructive CAD was defined as invasive FFR ≤0.80 or ≥70 % diameter stenosis by 3D-quantitative coronary angiography. Results: In total 404/445 patients had paired CT-QFR and invasive analyses of whom 149/404 (37 %) had hemodynamically obstructive CAD. MD-QFR and LS-QFR classified 188 (47 %) and 165 (41 %) patients as abnormal, respectively. Areas under the receiver-operating characteristic curve for MD-QFR was 0.83 vs. 0.85 for LS-QFR, p = 0.01. Sensitivities for MD-QFR and LS-QFR were 80 % (95%CI: 73–86) vs. 77 % (95%CI: 69–83), p = 0.03, respectively, and specificities were 73 % (95%CI: 67–78) vs. 80 % (95%CI: 75–85), p < 0.01, respectively. Positive predictive values for MD-QFR and LS-QFR were 63 % vs. 69 %, p < 0.01, respectively, and negative predictive values for MD-QFR and LS-QFR were 86 % vs. 85 %, p = 0.39, respectively). Conclusion: Using a lesion-specific CT-QFR approach has superior discrimination of hemodynamically obstructive CAD compared to a most distal CT-QFR approach. CT-QFR identified most cases of hemodynamically obstructive CAD while a normal CT-QFR excluded hemodynamically obstructive CAD in the majority of patients.",

keywords = "Computed tomography derived quantitative flow reserve, Coronary artery disease, Coronary computed tomography angiography, Fractional flow reserve, Non-invasive cardiac imaging, Quantitative coronary analysis",

author = "Dahl, {Jonathan N.} and Rasmussen, {Laust D.} and Daixin Ding and Shengxian Tu and Jelmer Westra and William Wijns and Christiansen, {Evald H{\o}j} and Ashkan Eftekhari and Guanyu Li and Simon Winther and Morten B{\o}ttcher",

year = "2024",

month = mar,

doi = "10.1016/j.jcct.2024.01.004",

language = "English",

volume = "18",

pages = "162--169",

journal = "Journal of Cardiovascular Computed Tomography",

issn = "1934-5925",

publisher = "Elsevier Inc.",

number = "2",

}

Dahl, JN , Rasmussen, LD, Ding, D, Tu, S, Westra, J, Wijns, W, Christiansen, EH, Eftekhari, A, Li, G, Winther, S & Bøttcher, M 2024, 'Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography', Journal of Cardiovascular Computed Tomography, bind 18, nr. 2, s. 162-169. https://doi.org/10.1016/j.jcct.2024.01.004

Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography. / Dahl, Jonathan N.; Rasmussen, Laust D.; Ding, Daixin et al.
I: Journal of Cardiovascular Computed Tomography, Bind 18, Nr. 2, 03.2024, s. 162-169.

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

TY - JOUR

T1 - Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography

AU - Dahl, Jonathan N.

AU - Rasmussen, Laust D.

AU - Ding, Daixin

AU - Tu, Shengxian

AU - Westra, Jelmer

AU - Wijns, William

AU - Christiansen, Evald Høj

AU - Eftekhari, Ashkan

AU - Li, Guanyu

AU - Winther, Simon

AU - Bøttcher, Morten

PY - 2024/3

Y1 - 2024/3

N2 - Background: Coronary computed tomography angiography (CCTA)-derived quantitative flow ratio (CT-QFR) is an on-site non-invasive technique estimating invasive fractional flow reserve (FFR). This study assesses the diagnostic performance of using most distal CT-QFR versus lesion-specific CT-QFR approach for identifying hemodynamically obstructive coronary artery disease (CAD). Methods: Prospectively enrolled de novo chest pain patients (n = 445) with ≥50 % visual diameter stenosis on CCTA were referred for invasive evaluation. On-site CT-QFR was analyzed post-hoc blinded to angiographic data and obtained as both most distal (MD-QFR) and lesion-specific CT-QFR (LS-QFR). Abnormal CT-QFR was defined as ≤0.80. Hemodynamically obstructive CAD was defined as invasive FFR ≤0.80 or ≥70 % diameter stenosis by 3D-quantitative coronary angiography. Results: In total 404/445 patients had paired CT-QFR and invasive analyses of whom 149/404 (37 %) had hemodynamically obstructive CAD. MD-QFR and LS-QFR classified 188 (47 %) and 165 (41 %) patients as abnormal, respectively. Areas under the receiver-operating characteristic curve for MD-QFR was 0.83 vs. 0.85 for LS-QFR, p = 0.01. Sensitivities for MD-QFR and LS-QFR were 80 % (95%CI: 73–86) vs. 77 % (95%CI: 69–83), p = 0.03, respectively, and specificities were 73 % (95%CI: 67–78) vs. 80 % (95%CI: 75–85), p < 0.01, respectively. Positive predictive values for MD-QFR and LS-QFR were 63 % vs. 69 %, p < 0.01, respectively, and negative predictive values for MD-QFR and LS-QFR were 86 % vs. 85 %, p = 0.39, respectively). Conclusion: Using a lesion-specific CT-QFR approach has superior discrimination of hemodynamically obstructive CAD compared to a most distal CT-QFR approach. CT-QFR identified most cases of hemodynamically obstructive CAD while a normal CT-QFR excluded hemodynamically obstructive CAD in the majority of patients.

AB - Background: Coronary computed tomography angiography (CCTA)-derived quantitative flow ratio (CT-QFR) is an on-site non-invasive technique estimating invasive fractional flow reserve (FFR). This study assesses the diagnostic performance of using most distal CT-QFR versus lesion-specific CT-QFR approach for identifying hemodynamically obstructive coronary artery disease (CAD). Methods: Prospectively enrolled de novo chest pain patients (n = 445) with ≥50 % visual diameter stenosis on CCTA were referred for invasive evaluation. On-site CT-QFR was analyzed post-hoc blinded to angiographic data and obtained as both most distal (MD-QFR) and lesion-specific CT-QFR (LS-QFR). Abnormal CT-QFR was defined as ≤0.80. Hemodynamically obstructive CAD was defined as invasive FFR ≤0.80 or ≥70 % diameter stenosis by 3D-quantitative coronary angiography. Results: In total 404/445 patients had paired CT-QFR and invasive analyses of whom 149/404 (37 %) had hemodynamically obstructive CAD. MD-QFR and LS-QFR classified 188 (47 %) and 165 (41 %) patients as abnormal, respectively. Areas under the receiver-operating characteristic curve for MD-QFR was 0.83 vs. 0.85 for LS-QFR, p = 0.01. Sensitivities for MD-QFR and LS-QFR were 80 % (95%CI: 73–86) vs. 77 % (95%CI: 69–83), p = 0.03, respectively, and specificities were 73 % (95%CI: 67–78) vs. 80 % (95%CI: 75–85), p < 0.01, respectively. Positive predictive values for MD-QFR and LS-QFR were 63 % vs. 69 %, p < 0.01, respectively, and negative predictive values for MD-QFR and LS-QFR were 86 % vs. 85 %, p = 0.39, respectively). Conclusion: Using a lesion-specific CT-QFR approach has superior discrimination of hemodynamically obstructive CAD compared to a most distal CT-QFR approach. CT-QFR identified most cases of hemodynamically obstructive CAD while a normal CT-QFR excluded hemodynamically obstructive CAD in the majority of patients.

KW - Computed tomography derived quantitative flow reserve

KW - Coronary artery disease

KW - Coronary computed tomography angiography

KW - Fractional flow reserve

KW - Non-invasive cardiac imaging

KW - Quantitative coronary analysis

UR - http://www.scopus.com/inward/record.url?scp=85185327321&partnerID=8YFLogxK

U2 - 10.1016/j.jcct.2024.01.004

DO - 10.1016/j.jcct.2024.01.004

M3 - Journal article

C2 - 38242777

SN - 1934-5925

VL - 18

SP - 162

EP - 169

JO - Journal of Cardiovascular Computed Tomography

JF - Journal of Cardiovascular Computed Tomography

IS - 2

ER -

Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography

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