Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease: The PERFECTION Study

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Abstract

Objectives: This study sought to compare the diagnostic accuracy of coronary computed tomography angiography (cCTA) with that of cCTA+fractional flow reserve derived from cCTA datasets (FFRCT) and that of cCTA+static stress-computed tomography perfusion (stress-CTP) in detecting functionally significant coronary artery lesions using invasive coronary angiography (ICA) plus invasive FFR as the reference standard. Background: FFRCT and static stress-CTP are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using cCTA. Methods: A total of 147 consecutive symptomatic patients scheduled for clinically indicated ICA+invasive FFR were evaluated with cCTA, FFRCT, and stress-CTP. Results: Vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values, and accuracy rates of cCTA were 99%, 76%, 100%, 61%, 82%, and 95%, 54%, 94%, 63%, 73%, respectively. cCTA+FFRCT showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 88%, 94%, 95%, 84%, 92%, and 90%, 85%, 92%, 83%, 87%, respectively. Finally, cCTA+stress-CTP showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 92%, 95%, 97%, 87%, 94% and 98%, 87%, 99%, 86%, 92%, respectively. Both FFRCT and stress-CTP significantly improved specificity and positive predictive values compared to those of cCTA alone. The area under the curve to detect flow-limiting stenoses of cCTA, cCTA+FFRCT, and cCTA+CTP were 0.89, 0.93, 0.92, and 0.90, 0.94, and 0.93 in a vessel-based and patient-based model, respectively, with significant additional values for both cCTA+FFRCT and cCTA+CTP versus cCTA alone (p < 0.001) but no differences between cCTA+FFRCT versus cCTA+CTP. Conclusions: FFRCT and stress-CTP in addition to cCTA are valid and comparable tools to evaluate the functional relevance of CAD.

Original languageEnglish
JournalJACC: Cardiovascular Imaging
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Coronary Artery Disease
Perfusion
Tomography
Cytidine Triphosphate
Computed Tomography Angiography
Coronary Angiography
Sensitivity and Specificity
Coronary Stenosis
Area Under Curve
Anatomy
Coronary Vessels

Keywords

  • accuracy
  • computed tomography
  • coronary artery disease
  • fractional flow reserve
  • perfusion

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{d04bab8cbf1541ecb5f4b5d5506cd1a8,
title = "Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease: The PERFECTION Study",
abstract = "Objectives: This study sought to compare the diagnostic accuracy of coronary computed tomography angiography (cCTA) with that of cCTA+fractional flow reserve derived from cCTA datasets (FFRCT) and that of cCTA+static stress-computed tomography perfusion (stress-CTP) in detecting functionally significant coronary artery lesions using invasive coronary angiography (ICA) plus invasive FFR as the reference standard. Background: FFRCT and static stress-CTP are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using cCTA. Methods: A total of 147 consecutive symptomatic patients scheduled for clinically indicated ICA+invasive FFR were evaluated with cCTA, FFRCT, and stress-CTP. Results: Vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values, and accuracy rates of cCTA were 99{\%}, 76{\%}, 100{\%}, 61{\%}, 82{\%}, and 95{\%}, 54{\%}, 94{\%}, 63{\%}, 73{\%}, respectively. cCTA+FFRCT showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 88{\%}, 94{\%}, 95{\%}, 84{\%}, 92{\%}, and 90{\%}, 85{\%}, 92{\%}, 83{\%}, 87{\%}, respectively. Finally, cCTA+stress-CTP showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 92{\%}, 95{\%}, 97{\%}, 87{\%}, 94{\%} and 98{\%}, 87{\%}, 99{\%}, 86{\%}, 92{\%}, respectively. Both FFRCT and stress-CTP significantly improved specificity and positive predictive values compared to those of cCTA alone. The area under the curve to detect flow-limiting stenoses of cCTA, cCTA+FFRCT, and cCTA+CTP were 0.89, 0.93, 0.92, and 0.90, 0.94, and 0.93 in a vessel-based and patient-based model, respectively, with significant additional values for both cCTA+FFRCT and cCTA+CTP versus cCTA alone (p < 0.001) but no differences between cCTA+FFRCT versus cCTA+CTP. Conclusions: FFRCT and stress-CTP in addition to cCTA are valid and comparable tools to evaluate the functional relevance of CAD.",
keywords = "accuracy, computed tomography, coronary artery disease, fractional flow reserve, perfusion",
author = "Gianluca Pontone and Andrea Baggiano and Daniele Andreini and Guaricci, {Andrea I.} and Marco Guglielmo and Giuseppe Muscogiuri and Laura Fusini and Fabio Fazzari and Saima Mushtaq and Edoardo Conte and Giuseppe Calligaris and {De Martini}, Stefano and Cristina Ferrari and Stefano Galli and Luca Grancini and Paolo Ravagnani and Giovanni Teruzzi and Daniela Trabattoni and Franco Fabbiocchi and Alessandro Lualdi and Piero Montorsi and Rabbat, {Mark G.} and Bartorelli, {Antonio L.} and Mauro Pepi",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jcmg.2018.08.023",
language = "English",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "NLM (Medline)",

}

TY - JOUR

T1 - Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease

T2 - The PERFECTION Study

AU - Pontone, Gianluca

AU - Baggiano, Andrea

AU - Andreini, Daniele

AU - Guaricci, Andrea I.

AU - Guglielmo, Marco

AU - Muscogiuri, Giuseppe

AU - Fusini, Laura

AU - Fazzari, Fabio

AU - Mushtaq, Saima

AU - Conte, Edoardo

AU - Calligaris, Giuseppe

AU - De Martini, Stefano

AU - Ferrari, Cristina

AU - Galli, Stefano

AU - Grancini, Luca

AU - Ravagnani, Paolo

AU - Teruzzi, Giovanni

AU - Trabattoni, Daniela

AU - Fabbiocchi, Franco

AU - Lualdi, Alessandro

AU - Montorsi, Piero

AU - Rabbat, Mark G.

AU - Bartorelli, Antonio L.

AU - Pepi, Mauro

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: This study sought to compare the diagnostic accuracy of coronary computed tomography angiography (cCTA) with that of cCTA+fractional flow reserve derived from cCTA datasets (FFRCT) and that of cCTA+static stress-computed tomography perfusion (stress-CTP) in detecting functionally significant coronary artery lesions using invasive coronary angiography (ICA) plus invasive FFR as the reference standard. Background: FFRCT and static stress-CTP are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using cCTA. Methods: A total of 147 consecutive symptomatic patients scheduled for clinically indicated ICA+invasive FFR were evaluated with cCTA, FFRCT, and stress-CTP. Results: Vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values, and accuracy rates of cCTA were 99%, 76%, 100%, 61%, 82%, and 95%, 54%, 94%, 63%, 73%, respectively. cCTA+FFRCT showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 88%, 94%, 95%, 84%, 92%, and 90%, 85%, 92%, 83%, 87%, respectively. Finally, cCTA+stress-CTP showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 92%, 95%, 97%, 87%, 94% and 98%, 87%, 99%, 86%, 92%, respectively. Both FFRCT and stress-CTP significantly improved specificity and positive predictive values compared to those of cCTA alone. The area under the curve to detect flow-limiting stenoses of cCTA, cCTA+FFRCT, and cCTA+CTP were 0.89, 0.93, 0.92, and 0.90, 0.94, and 0.93 in a vessel-based and patient-based model, respectively, with significant additional values for both cCTA+FFRCT and cCTA+CTP versus cCTA alone (p < 0.001) but no differences between cCTA+FFRCT versus cCTA+CTP. Conclusions: FFRCT and stress-CTP in addition to cCTA are valid and comparable tools to evaluate the functional relevance of CAD.

AB - Objectives: This study sought to compare the diagnostic accuracy of coronary computed tomography angiography (cCTA) with that of cCTA+fractional flow reserve derived from cCTA datasets (FFRCT) and that of cCTA+static stress-computed tomography perfusion (stress-CTP) in detecting functionally significant coronary artery lesions using invasive coronary angiography (ICA) plus invasive FFR as the reference standard. Background: FFRCT and static stress-CTP are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using cCTA. Methods: A total of 147 consecutive symptomatic patients scheduled for clinically indicated ICA+invasive FFR were evaluated with cCTA, FFRCT, and stress-CTP. Results: Vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values, and accuracy rates of cCTA were 99%, 76%, 100%, 61%, 82%, and 95%, 54%, 94%, 63%, 73%, respectively. cCTA+FFRCT showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 88%, 94%, 95%, 84%, 92%, and 90%, 85%, 92%, 83%, 87%, respectively. Finally, cCTA+stress-CTP showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 92%, 95%, 97%, 87%, 94% and 98%, 87%, 99%, 86%, 92%, respectively. Both FFRCT and stress-CTP significantly improved specificity and positive predictive values compared to those of cCTA alone. The area under the curve to detect flow-limiting stenoses of cCTA, cCTA+FFRCT, and cCTA+CTP were 0.89, 0.93, 0.92, and 0.90, 0.94, and 0.93 in a vessel-based and patient-based model, respectively, with significant additional values for both cCTA+FFRCT and cCTA+CTP versus cCTA alone (p < 0.001) but no differences between cCTA+FFRCT versus cCTA+CTP. Conclusions: FFRCT and stress-CTP in addition to cCTA are valid and comparable tools to evaluate the functional relevance of CAD.

KW - accuracy

KW - computed tomography

KW - coronary artery disease

KW - fractional flow reserve

KW - perfusion

UR - http://www.scopus.com/inward/record.url?scp=85055095240&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055095240&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2018.08.023

DO - 10.1016/j.jcmg.2018.08.023

M3 - Article

AN - SCOPUS:85055095240

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

ER -