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Meinel FG, Schoepf UJ, Townsend JC, Flowers BA, Geyer LL, Ebersberger U, Krazinski AW, Kunz WG, Thierfelder KM, Baker DW, Khan AM, Fernandes VL, O'Brien TX. Diagnostic yield and accuracy of coronary CT angiography after abnormal nuclear myocardial perfusion imaging. Sci Rep 2018; 8:9228. [PMID: 29907855 PMCID: PMC6003932 DOI: 10.1038/s41598-018-27347-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/09/2018] [Indexed: 11/18/2022] Open
Abstract
We aimed to determine the diagnostic yield and accuracy of coronary CT angiography (CCTA) in patients referred for invasive coronary angiography (ICA) based on clinical concern for coronary artery disease (CAD) and an abnormal nuclear stress myocardial perfusion imaging (MPI) study. We enrolled 100 patients (84 male, mean age 59.6 ± 8.9 years) with an abnormal MPI study and subsequent referral for ICA. Each patient underwent CCTA prior to ICA. We analyzed the prevalence of potentially obstructive CAD (≥50% stenosis) on CCTA and calculated the diagnostic accuracy of ≥50% stenosis on CCTA for the detection of clinically significant CAD on ICA (defined as any ≥70% stenosis or ≥50% left main stenosis). On CCTA, 54 patients had at least one ≥50% stenosis. With ICA, 45 patients demonstrated clinically significant CAD. A positive CCTA had 100% sensitivity and 84% specificity with a 100% negative predictive value and 83% positive predictive value for clinically significant CAD on a per patient basis in MPI positive symptomatic patients. In conclusion, almost half (48%) of patients with suspected CAD and an abnormal MPI study demonstrate no obstructive CAD on CCTA.
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Affiliation(s)
- Felix G Meinel
- Heart and Vascular Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Diagnostic and Interventional Radiology, Rostock University Medical Center, Rostock, Germany
| | - U Joseph Schoepf
- Heart and Vascular Center, Medical University of South Carolina, Charleston, SC, USA. .,Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | | | | | - Lucas L Geyer
- Heart and Vascular Center, Medical University of South Carolina, Charleston, SC, USA.,Center for Radiology and Neuroradiology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - Ullrich Ebersberger
- Heart and Vascular Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Wolfgang G Kunz
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Kolja M Thierfelder
- Department of Diagnostic and Interventional Radiology, Rostock University Medical Center, Rostock, Germany
| | - Deborah W Baker
- Charles George Veterans Affairs Medical Center, Asheville, NC, USA
| | - Ashan M Khan
- Department of Radiology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Valerian L Fernandes
- Heart and Vascular Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Terrence X O'Brien
- Heart and Vascular Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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Cheruvu C, Naoum C, Blanke P, Norgaard B, Leipsic J. Beyond Stenosis With Fractional Flow Reserve Via Computed Tomography and Advanced Plaque Analyses for the Diagnosis of Lesion-Specific Ischemia. Can J Cardiol 2016; 32:1315.e1-1315.e9. [PMID: 27032888 DOI: 10.1016/j.cjca.2016.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/14/2015] [Accepted: 01/04/2016] [Indexed: 12/24/2022] Open
Abstract
In the treatment of stable coronary artery disease (CAD), the determination of stenosis severity by invasive coronary angiography (ICA) is a critical procedure, and for borderline lesions, the detection of ischemia through invasive fractional flow reserve (FFR) is the gold standard. With advances in computational fluid dynamics, FFR can now be calculated noninvasively using anatomic data from coronary computed tomographic angiography (CCTA). This technique is known as FFRCT. The purpose of this review is to summarize the science of FFRCT, describe its diagnostic accuracy, discuss its clinical and economic impact, and elucidate factors beyond stenosis severity that may mechanistically relate to lesion-specific ischemia. These factors include adverse atherosclerotic plaque characteristics such as positive remodelling, low-attenuation plaque, and spotty calcification, as well as aggregate plaque volume. These factors can be appreciated noninvasively by CCTA but not by ICA. The diagnostic accuracy of FFRCT, compared with the gold standard of FFR, has been validated in 3 prospective multicentre blinded core laboratory-controlled trials, and as a result FFRCT has been approved by the US Food and Drug Administration for clinical use. FFRCT has also been shown in a clinical utility trial to better identify patients without obstructive CAD when compared with standard noninvasive assessment of stable CAD, thereby avoiding unnecessary angiograms. In addition, the use of FFRCT has been shown to allow for a significant cost savings compared with traditional care. It is therefore important for cardiologists to appreciate the value of this important new methodology.
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Affiliation(s)
- Chaitu Cheruvu
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Naoum
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bjarne Norgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
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Agus AM, McKavanagh P, Lusk L, Verghis RM, Walls GM, Ball PA, Trinick TR, Harbinson MT, Donnelly PM. The cost-effectiveness of cardiac computed tomography for patients with stable chest pain. Heart 2016; 102:356-62. [DOI: 10.1136/heartjnl-2015-308247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 11/30/2015] [Indexed: 11/04/2022] Open
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Min JK, Taylor CA, Achenbach S, Koo BK, Leipsic J, Nørgaard BL, Pijls NJ, De Bruyne B. Noninvasive Fractional Flow Reserve Derived From Coronary CT Angiography. JACC Cardiovasc Imaging 2015; 8:1209-1222. [DOI: 10.1016/j.jcmg.2015.08.006] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 11/25/2022]
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Cademartiri F, Maffei E, Arcadi T, Catalano O, Midiri M. CT coronary angiography at an ultra-low radiation dose (<0.1 mSv): feasible and viable in times of constraint on healthcare costs. Eur Radiol 2013; 23:607-13. [PMID: 23344906 DOI: 10.1007/s00330-012-2767-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/13/2012] [Accepted: 12/19/2012] [Indexed: 11/29/2022]
Abstract
Computed tomography coronary angiography (CTCA) has reached very high standards both in terms of diagnostic performance and radiation dose reduction. This commentary follows a report on CTCA using less than 0.1 mSv in selected patients. This is an extraordinary accomplishment, both for technology and for medicine. The difficult task is now to implement this tool in clinical practice so it can play the best possible role. CTCA can improve diagnostic pathways, can save money for healthcare systems and could even improve pharmacological therapy. All of this may happen, but it will require the combined effort of all the experienced operators in this field, including the referring clinicians. In times of financial constraint, CTCA may also help to restrict ineffective medical expenses.
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Affiliation(s)
- Filippo Cademartiri
- Department of Radiology, Erasmus Medical Center University, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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