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Ma Z, Tu C, Zhang B, Zhang D, Song X, Zhang H. A meta-analysis comparing the diagnostic performance of computed tomography-derived fractional flow reserve and coronary computed tomography angiography at different levels of coronary artery calcium score. Eur Radiol 2024:10.1007/s00330-024-10591-0. [PMID: 38334761 DOI: 10.1007/s00330-024-10591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/30/2023] [Accepted: 11/30/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVES The impact of coronary calcification on the diagnostic accuracy of computed tomography-derived fractional flow reserve (CT-FFR) and coronary computed tomography angiography (CCTA) remains a crucial consideration. This meta-analysis aims to compare the diagnostic performance of CT-FFR and CCTA at different levels of coronary artery calcium score (CACS). METHODS AND RESULTS We searched PubMed, Embase, and the Cochrane Library for relevant articles on CCTA, CT-FFR, and invasive fractional flow reserve (FFR). Ten studies were included to evaluate the diagnostic performance of CT-FFR and CCTA at the per-patient and per-vessel levels in four CACS groups. Invasive FFR was used as the reference standard. Except for the CACS ≥ 400 group, the AUC of CT-FFR was higher than those of CCTA in other subgroups of CACS (in CACS < 100 (per-patient, 0.9 (95% CI 0.87-0.92) vs. 0.32 (95% CI 0.28-0.36); per-vessel, 0.92 (95% CI 0.89-0.94) vs. 0.66 (95% CI 0.62-0.7); both p < 0.001), CACS ≥ 100 (per-patient, 0.86 (95% CI 0.82-0.88) vs. 0.44 (95% CI 0.4-0.48); per-vessel, 0.88 (95% CI 0.85-0.9) vs. 0.51 (95% CI 0.46-0.55); both p < 0.001), and CACS < 400 (per-patient, 0.9 (95% CI 0.87-0.93) vs. 0.74 (95% CI 0.7-0.78), p < 0.001; per-vessel, 0.8 (95% CI 0.76-0.83) vs. 0.74 (95% CI 0.7-0.78); p = 0.02)). CONCLUSIONS CT-FFR demonstrates superior diagnostic performance in low CACS groups (CACS < 400) than CCTA in detecting hemodynamic stenoses in patients with coronary artery disease (CAD). CLINICAL RELEVANCE STATEMENT Computed tomography-derived fractional flow reserve might be utilized to determine the necessity of invasive coronary angiography in coronary artery disease patients with coronary artery calcium score < 400. KEY POINTS • There is a lack of meta-analysis comparing the diagnostic performance of computed tomography-derived fractional flow reserve and coronary computed tomography angiography at different levels of calcification. • Computed tomography-derived fractional flow reserve only has a better diagnostic performance than coronary computed tomography angiography with low amounts of coronary calcium. • For the low coronary artery calcium score group, computed tomography-derived fractional flow reserve might be a good non-invasive method to detect hemodynamic stenoses in coronary artery disease patients.
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Affiliation(s)
- Zhao Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Chenchen Tu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Baoen Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Dongfeng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China.
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China.
| | - Hongjia Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
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Huang Z, Ding Y, Yang Y, Zhao S, Zhang S, Xiao J, Ding C, Guo N, Li Z, Zhou S, Cao G, Wang X. Performance of machine learning-based coronary computed tomography angiography for selecting revascularization candidates. Acta Radiol 2024; 65:123-132. [PMID: 36847335 DOI: 10.1177/02841851231158730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Limited studies have investigated the accuracy of therapeutic decision-making using machine learning-based coronary computed tomography angiography (ML-CCTA) compared with CCTA. PURPOSE To investigate the performance of ML-CCTA for therapeutic decision compared with CCTA. MATERIAL AND METHODS The study population consisted of 322 consecutive patients with stable coronary artery disease. The SYNTAX score was calculated with an online calculator based on ML-CCTA results. Therapeutic decision-making was determined by ML-CCTA results and the ML-CCTA-based SYNTAX score. The therapeutic strategy and the appropriate revascularization procedure were selected using ML-CCTA, CCTA, and invasive coronary angiography (ICA) independently. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, accuracy of ML-CCTA and CCTA for selecting revascularization candidates were 87.01%, 96.43%, 95.71%, 89.01%, 91.93%, and 85.71%, 87.50%, 86.27%, 86.98%, 86.65%, respectively, using ICA as the standard reference. The area under the receiver operating characteristic curve (AUC) of ML-CCTA for selecting revascularization candidates was significantly higher than CCTA (0.917 vs. 0.866, P = 0.016). Subgroup analysis showed the AUC of ML-CCTA for selecting percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) candidates was significantly higher than CCTA (0.883 vs. 0.777, P < 0.001, 0.912 vs. 0.826, P = 0.003, respectively). CONCLUSION ML-CCTA could distinguish between patients who need revascularization and those who do not. In addition, ML-CCTA showed a slightly superior to CCTA in making an appropriate decision for patients and selecting a suitable revascularization strategy.
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Affiliation(s)
- Zengfa Huang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Ding
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Yang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengchao Zhao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shutong Zhang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianwei Xiao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengyu Ding
- Shukun (Beijing) Technology Co., Ltd., Beijing, China
| | - Ning Guo
- Shukun (Beijing) Technology Co., Ltd., Beijing, China
| | - Zuoqin Li
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiguang Zhou
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guijuan Cao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yang F, Pang Z, Yang Z, Yang Y, Wang Y, Jia P, Wang D, Cui S. Value of CT‑derived fractional flow reserve in identifying patients with acute myocardial infarction based on coronary computed tomography angiography. Exp Ther Med 2023; 26:558. [PMID: 37941593 PMCID: PMC10628645 DOI: 10.3892/etm.2023.12258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/07/2023] [Indexed: 11/10/2023] Open
Abstract
The aim of the present study was to determine whether coronary stenosis and computed tomography-derived fractional flow reserve (CT-FFR), detected by coronary computed tomography angiography (CCTA), can potentially contribute to distinguish acute myocardial infarction (AMI) from unstable angina (UA). The study retrospectively collected data from consecutive patients who were admitted with obstructive coronary artery disease (CAD) and who received CCTA and invasive coronary angiography (ICA) as part of their clinical workup. According to the inclusion criteria, the patients were divided into the AMI group and UA group, and the basic clinical data, CCTA stenosis degree and CT-FFR values were compared between the two groups. Univariate and multivariate logistic regression methods were used to analyze the association between ≥70% CCTA stenosis, ≤0.80 CT-FFR and AMI. A diagnostic model of AMI was established (model 1, ≤0.80 CT-FFR; model 2, ≥70% CCTA stenosis; and model 3, ≤0.80 CT-FFR combined with ≥70% CCTA stenosis), and the diagnostic efficacy of the three models for AMI was compared. The significance level was set at P<0.05. A total of 116 participants were finally enrolled in this study. There were 37 patients in the AMI group, with an average age of 62.06±7.74 years, and 79 patients in the UA group, with an average age of 58.11±10.0 years; there was no significant difference in age (P>0.05). The multivariate regression analysis revealed that ≤0.80 CT-FFR (HR=28.074; 95% CI: 5.712-137.973; P<0.001), and ≥70% CCTA stenosis (HR=10.796; 95% CI: 2.566-45.425; P=0.001) were independent risk factors for AMI. The diagnostic model of ≤0.80 CT-FFR combined with ≥70% CCTA stenosis (AUC=0.914; 95% CI: 0.847-0.958) exhibited increased diagnosis performance than the ≤0.80 CT-FFR model (AUC=0.865; 95% CI: 0.790-0.922; P=0.0060) and the ≥70% CCTA stenosis model (AUC=0.827; 95% CI: 0.745-0.891; P=0.0008). Collectively, it was demonstrated that ≤0.80 CT-FFR and ≥70% CCTA stenosis were independent risk factors for the diagnosis of AMI, and the combination of CT-FFR and CCTA stenosis further improved AMI diagnosis performance.
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Affiliation(s)
- Fei Yang
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei 075000, P.R. China
| | - Zhiying Pang
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei 075000, P.R. China
| | - Zhixiang Yang
- Graduate School, Hebei North University, Zhangjiakou, Hebei 075000, P.R. China
| | - Yue Yang
- Graduate School, Hebei North University, Zhangjiakou, Hebei 075000, P.R. China
| | - Yanfei Wang
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei 075000, P.R. China
| | - Peng Jia
- Department of Medical Imaging, Beijing Huairou Hospital, Beijing 101400, P.R. China
| | - Dawei Wang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei 075000, P.R. China
| | - Shujun Cui
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei 075000, P.R. China
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Patel P, Emrich T, Schoepf UJ, Mehta V, Bayer RR, von Assen M, Giovagnoli V, Jeudy J, Varga-Szemes A, White C. Comprehensive Computed Tomography Imaging of Vessel-specific and Lesion-specific Myocardial Ischemia. J Thorac Imaging 2023; 38:212-225. [PMID: 34029280 DOI: 10.1097/rti.0000000000000592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Coronary computed tomographic angiography (CCTA) has emerged as a fast and robust tool with high sensitivity and excellent negative predictive value for the evaluation of coronary artery disease, but is unable to estimate the hemodynamic significance of a lesion. Advances in computed tomography (CT)-based diagnostic techniques, for example, CT-derived fractional flow reserve and CT perfusion, have helped transform CCTA primarily from an anatomic assessment tool to a technique that is able to provide both anatomic and functional information for a stenosis. With the results of the ISCHEMIA trial published in 2019, these advanced techniques can elevate CCTA into the role of a better gatekeeper for decision-making and can help guide referral for invasive management. In this article, we review the principles, limitations, diagnostic performance, and clinical utility of these 2 functional CT-based techniques in the evaluation of vessel-specific and lesion-specific ischemia.
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Affiliation(s)
- Pratik Patel
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Tilman Emrich
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Varun Mehta
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Richard R Bayer
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC
| | - Marly von Assen
- Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging, Emory University Hospital, Atlanta, GA
| | - Vincent Giovagnoli
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Jean Jeudy
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Charles White
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
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Qiao HY, Wu Y, Li HC, Zhang HY, Wu QH, You QJ, Ma X, Hu SD. Role of Quantitative Plaque Analysis and Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography to Assess Plaque Progression. J Thorac Imaging 2023; 38:186-193. [PMID: 36728026 PMCID: PMC10128899 DOI: 10.1097/rti.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To explore the role of quantitative plaque analysis and fractional flow reserve (CT-FFR) derived from coronary computed angiography (CCTA) in evaluating plaque progression (PP). METHODS A total of 248 consecutive patients who underwent serial CCTA examinations were enrolled. All patients' images were analyzed quantitatively by plaque analysis software. The quantitative analysis indexes included diameter stenosis (%DS), plaque length, plaque volume (PV), calcified PV, noncalcified PV, minimum lumen area (MLA), and remodeling index (RI). PP is defined as PAV (percentage atheroma volume) change rate >1%. CT-FFR analysis was performed using the cFFR software. RESULTS A total of 76 patients (30.6%) and 172 patients (69.4%) were included in the PP group and non-PP group, respectively. Compared with the non-PP group, the PP group showed greater %DS, smaller MLA, larger PV and non-calcified PV, larger RI, and lower CT-FFR on baseline CCTA (all P <0.05). Logistic regression analysis showed that RI≥1.10 (odds ratio [OR]: 2.709, 95% CI: 1.447-5.072), and CT-FFR≤0.85 (OR: 5.079, 95% CI: 2.626-9.283) were independent predictors of PP. The model based on %DS, quantitative plaque features, and CT-FFR (area under the receiver-operating characteristics curve [AUC]=0.80, P <0.001) was significantly better than that based rarely on %DS (AUC=0.61, P =0.007) and that based on %DS and quantitative plaque characteristics (AUC=0.72, P <0.001). CONCLUSIONS Quantitative plaque analysis and CT-FFR are helpful to identify PP. RI and CT-FFR are important predictors of PP. Compared with the prediction model only depending on %DS, plaque quantitative markers and CT-FFR can further improve the predictive performance of PP.
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Affiliation(s)
| | - Yong Wu
- Departments of Medical Imaging
| | - Hai Cheng Li
- Department of Medical Imaging, Minhe County People’s Hospital, Haidong, Qing hai, China
| | - Hai Yan Zhang
- Department of Medical Imaging, Minhe County People’s Hospital, Haidong, Qing hai, China
| | | | - Qing Jun You
- Thoracic Surgery, Affiliated Hospital of Jiangnan University
| | - Xin Ma
- School of Medicine, Jiangnan University, Wuxi, Jiangsu
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Schuessler M, Saner F, Al-Rashid F, Schlosser T. Diagnostic accuracy of coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) in patients before liver transplantation using CT-FFR machine learning algorithm. Eur Radiol 2022; 32:8761-8768. [PMID: 35729425 DOI: 10.1007/s00330-022-08921-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/19/2022] [Accepted: 05/30/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Liver transplantation (LT) is associated with high stress on the cardiovascular system. Ruling out coronary artery disease (CAD) is an important part of evaluation for LT. The aim of our study was to assess whether CT-derived fractional flow reserve (CT-FFR) allows for differentiation of hemodynamically significant and non-significant coronary stenosis in patients evaluated for LT. METHODS In total, 201 patients undergoing LT evaluation were included in the study. The patients received coronary computed tomography angiography (CCTA) to rule out CAD and invasive coronary angiography (ICA) to further evaluate coronary lesions found in CCTA if a significant (≥ 50 % on CCTA) stenosis was suspected. CT-FFR was computed from CCTA datasets using a machine learning-based algorithm and compared to ICA as a standard of reference. Coronary lesions with CT-FFR ≤ 0.80 were defined as hemodynamically significant. RESULTS In 127 of 201 patients (63%), an obstructive CAD was ruled out by CCTA. In the remaining 74 patients (37%), at least one significant stenosis was suspected in CCTA. Compared to ICA, sensitivity, specificity, PPV, and NPV of the CT-FFR measurements were 71% (49-92%), 90% (82-98%), 67% (45-88%), and 91% (84-99%), respectively. The diagnostic accuracy was 85% (85-86%). In 69% of cases (52 of 75 lesions), additional analysis by CT-FFR correctly excluded the hemodynamic significance of the stenosis. CONCLUSIONS Machine learning-based CT-FFR seems to be a very promising noninvasive approach for exclusion of hemodynamic significant coronary stenoses in patients undergoing evaluation for LT and could help to reduce the rate of invasive coronary angiography in this high-risk population. KEY POINTS • Machine learning-based computed tomography-derived fractional flow reserve (CT-FFR) seems to be a very promising noninvasive approach for exclusion of hemodynamic significance of coronary stenoses in patients undergoing evaluation for liver transplantation and could help to reduce the rate of invasive coronary angiography in this high-risk population.
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Affiliation(s)
- Maximilian Schuessler
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - Fuat Saner
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Fadi Al-Rashid
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Thomas Schlosser
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Chi Z, Beile L, Deyu L, Yubo F. Application of multiscale coupling models in the numerical study of circulation system. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Freitas SA, Nienow D, da Costa CA, Ramos GDO. Functional Coronary Artery Assessment: a Systematic Literature Review. Wien Klin Wochenschr 2021; 134:302-318. [PMID: 34870740 DOI: 10.1007/s00508-021-01970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
Cardiovascular diseases represent the number one cause of death in the world, including the most common disorders in the heart's health, namely coronary artery disease (CAD). CAD is mainly caused by fat accumulated in the arteries' internal walls, creating an atherosclerotic plaque that impacts the blood flow functional behavior. Anatomical plaque characteristics are essential but not sufficient for a complete functional assessment of CAD. In fact, plaque analysis and visual inspection alone have proven insufficient to determine the lesion severity and hemodynamic repercussion. Furthermore, the fractional flow reserve (FFR) exam, which is considered the gold standard for stenosis functional impair determination, is invasive and contains several limitations. Such a panorama evidences the need for new techniques applied to image exams to improve CAD functional assessment. In this article, we perform a systematic literature review on emerging methods determining CAD significance, thus delivering a unique base for comparing these methods, qualitatively and quantitatively. Our goal is to guide further studies with evidence from the most promising methods, highlighting the benefits from both areas. We summarize benchmarks, metrics for evaluation, and challenges already faced, thus shedding light on the requirements for a valid, meaningful, and accepted technique for functional assessment evaluation. We create a base of comparison based on quantitative and qualitative indicators and highlight the most relevant geometrical metrics that correlate with lesion significance. Finally, we point out future benchmarks based on recent literature.
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Affiliation(s)
- Samuel A Freitas
- Software Innovation Laboratory, Graduate Program in Applied Computing, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
| | - Débora Nienow
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Cristiano A da Costa
- Software Innovation Laboratory, Graduate Program in Applied Computing, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
| | - Gabriel de O Ramos
- Software Innovation Laboratory, Graduate Program in Applied Computing, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil.
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Aquino GJ, Abadia AF, Schoepf UJ, Emrich T, Yacoub B, Kabakus I, Violette A, Wiley C, Moreno A, Sahbaee P, Schwemmer C, Bayer RR, Varga-Szemes A, Steinberg D, Amoroso N, Kocher M, Waltz J, Ward TJ, Burt JR. Coronary CT Fractional Flow Reserve before Transcatheter Aortic Valve Replacement: Clinical Outcomes. Radiology 2021; 302:50-58. [PMID: 34609200 DOI: 10.1148/radiol.2021210160] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background The role of CT angiography-derived fractional flow reserve (CT-FFR) in pre-transcatheter aortic valve replacement (TAVR) assessment is uncertain. Purpose To evaluate the predictive value of on-site machine learning-based CT-FFR for adverse clinical outcomes in candidates for TAVR. Materials and Methods This observational retrospective study included patients with severe aortic stenosis referred to TAVR after coronary CT angiography (CCTA) between September 2014 and December 2019. Clinical end points comprised major adverse cardiac events (MACE) (nonfatal myocardial infarction, unstable angina, cardiac death, or heart failure admission) and all-cause mortality. CT-FFR was obtained semiautomatically using an on-site machine learning algorithm. The ability of CT-FFR (abnormal if ≤0.75) to predict outcomes and improve the predictive value of the current noninvasive work-up was assessed. Survival analysis was performed, and the C-index was used to assess the performance of each predictive model. To compare nested models, the likelihood ratio χ2 test was performed. Results A total of 196 patients (mean age ± standard deviation, 75 years ± 11; 110 women [56%]) were included; the median time of follow-up was 18 months. MACE occurred in 16% (31 of 196 patients) and all-cause mortality in 19% (38 of 196 patients). Univariable analysis revealed CT-FFR was predictive of MACE (hazard ratio [HR], 4.1; 95% CI: 1.6, 10.8; P = .01) but not all-cause mortality (HR, 1.2; 95% CI: 0.6, 2.2; P = .63). CT-FFR was independently associated with MACE (HR, 4.0; 95% CI: 1.5, 10.5; P = .01) when adjusting for potential confounders. Adding CT-FFR as a predictor to models that include CCTA and clinical data improved their predictive value for MACE (P = .002) but not all-cause mortality (P = .67), and it showed good discriminative ability for MACE (C-index, 0.71). Conclusion CT angiography-derived fractional flow reserve was associated with major adverse cardiac events in candidates for transcatheter aortic valve replacement and improved the predictive value of coronary CT angiography assessment. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Choe in this issue.
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Affiliation(s)
- Gilberto J Aquino
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Andres F Abadia
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - U Joseph Schoepf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Tilman Emrich
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Basel Yacoub
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Ismail Kabakus
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Alexis Violette
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Courtney Wiley
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Andreina Moreno
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Pooyan Sahbaee
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Chris Schwemmer
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Richard R Bayer
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Akos Varga-Szemes
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Daniel Steinberg
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Nicholas Amoroso
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Madison Kocher
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Jeffrey Waltz
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Thomas J Ward
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
| | - Jeremy R Burt
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.)
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10
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Li Y, Jia K, Jia Y, Yang Y, Yao Y, Chen M, Peng Y. Understanding the predictive value and methods of risk assessment based on coronary computed tomographic angiography in populations with coronary artery disease: a review. PRECISION CLINICAL MEDICINE 2021; 4:192-203. [PMID: 35693218 PMCID: PMC8982592 DOI: 10.1093/pcmedi/pbab018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 02/05/2023] Open
Abstract
Risk assessment in coronary artery disease plays an essential role in the early identification of high-risk patients. However, conventional invasive imaging procedures all require long intraprocedural times and high costs. The rapid development of coronary computed tomographic angiography (CCTA) and related image processing technology has facilitated the formulation of noninvasive approaches to perform comprehensive evaluations. Evidence has shown that CCTA has outstanding performance in identifying the degree of stenosis, plaque features, and functional reserve. Moreover, advancements in radiomics and machine learning allow more comprehensive interpretations of CCTA images. This paper reviews conventional as well as novel diagnostic and risk assessment tools based on CCTA.
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Affiliation(s)
- Yiming Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kaiyu Jia
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yuheng Jia
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yong Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yijun Yao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
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11
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Tang CX, Guo BJ, Schoepf JU, Bayer RR, Liu CY, Qiao HY, Zhou F, Lu GM, Zhou CS, Zhang LJ. Feasibility and prognostic role of machine learning-based FFR CT in patients with stent implantation. Eur Radiol 2021; 31:6592-6604. [PMID: 33864504 DOI: 10.1007/s00330-021-07922-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/25/2021] [Accepted: 03/22/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To investigate the feasibility and prognostic implications of coronary CT angiography (CCTA) derived fractional flow reserve (FFRCT) in patients who have undergone stents implantation. METHODS Firstly, the feasibility of FFRCT in stented vessels was validated. The diagnostic performance of FFRCT in identifying hemodynamically in-stent restenosis (ISR) in 33 patients with invasive FFR ≤ 0.88 as reference standard, intra-group correlation coefficient (ICC) between FFRCT and FFR was calculated. Secondly, prognostic value was assessed with 115 patients with serial CCTA scans after PCI. Stent characteristics (location, diameter, length, etc.), CCTA measurements (minimum lumen diameter [MLD], minimum lumen area [MLA], ISR), and FFRCT measurements (FFRCT, ΔFFRCT, ΔFFRCT/stent length) both at baseline and follow-up were recorded. Longitudinal analysis included changes of MLD, MLA, ISR, and FFRCT. The primary endpoint was major adverse cardiovascular events (MACE). RESULTS Per-patient accuracy of FFRCT was 0.85 in identifying hemodynamically ISR. FFRCT had a good correlation with FFR (ICC = 0.84). 15.7% (18/115) developed MACE during 25 months since follow-up CCTA. Lasso regression identified age and follow-up ΔFFRCT/length as candidate variables. In the Cox proportional hazards model, age (hazard ratio [HR], 1.102 [95% CI, 1.032-1.177]; p = 0.004) and follow-up ΔFFRCT/length (HR, 1.014 [95% CI, 1.006-1.023]; p = 0.001) were independently associated with MACE (c-index = 0.856). Time-dependent ROC analysis showed AUC was 0.787 (95% CI, 0.594-0.980) at 25 months to predict adverse outcome. After bootstrap validation with 1000 resamplings, the bias-corrected c-index was 0.846. CONCLUSIONS Noninvasive ML-based FFRCT is feasible in patients following stents implantation and shows prognostic value in predicting adverse events after stents implantation in low-moderate risk patients. KEY POINTS • Machine-learning-based FFRCT is feasible to evaluate the functional significance of in-stent restenosis in patients with stent implantation. • Follow-up △FFRCT along with the stent length might have prognostic implication in patients with stent implantation and low-to-moderate risk after 2 years follow-up. The prognostic role of FFRCT in patients with moderate-to-high or high risk needs to be further studied. • FFRCT might refine the clinical pathway of patients with stent implantation to invasive catheterization.
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Affiliation(s)
- Chun Xiang Tang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Bang Jun Guo
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Joseph U Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Chun Yu Liu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Hong Yan Qiao
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Fan Zhou
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Chang Sheng Zhou
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
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12
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Koo HJ, Kang JW, Kang SJ, Kweon J, Lee JG, Ahn JM, Park DW, Lee SW, Lee CW, Park SW, Park SJ, Kim YH, Yang DH. Impact of coronary calcium score and lesion characteristics on the diagnostic performance of machine-learning-based computed tomography-derived fractional flow reserve. Eur Heart J Cardiovasc Imaging 2021; 22:998-1006. [PMID: 33842953 DOI: 10.1093/ehjci/jeab062] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/18/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS To evaluate the impact of coronary artery calcium (CAC) score, minimal lumen area (MLA), and length of coronary artery stenosis on the diagnostic performance of the machine-learning-based computed tomography-derived fractional flow reserve (ML-FFR). METHODS AND RESULTS In 471 patients with coronary artery disease, computed tomography angiography (CTA) and invasive coronary angiography were performed with fractional flow reserve (FFR) in 557 lesions at a single centre. Diagnostic performances of ML-FFR, computational fluid dynamics-based CT-FFR (CFD-FFR), MLA, quantitative coronary angiography (QCA), and visual stenosis grading were evaluated using invasive FFR as a reference standard. Diagnostic performances were analysed according to lesion characteristics including the MLA, length of stenosis, CAC score, and stenosis degree. ML-FFR was obtained by automated feature selection and model building from quantitative CTA. A total of 272 lesions showed significant ischaemia, defined by invasive FFR ≤0.80. There was a significant correlation between CFD-FFR and ML-FFR (r = 0.99, P < 0.001). ML-FFR showed moderate sensitivity and specificity in the per-patient analysis. Diagnostic performances of CFD-FFR and ML-FFR did not decline in patients with high CAC scores (CAC > 400). Sensitivities of CFD-FFR and ML-FFR showed a downward trend along with the increase in lesion length and decrease in MLA. The area under the curve (AUC) of ML-FFR (0.73) was higher than those of QCA and visual grading (AUC = 0.65 for both, P < 0.001) and comparable to those of MLA (AUC = 0.71, P = 0.21) and CFD-FFR (AUC = 0.73, P = 0.86). CONCLUSION ML-FFR showed comparable results to MLA and CFD-FFR for the prediction of lesion-specific ischaemia. Specificities and accuracies of CFD-FFR and ML-FFR decreased with smaller MLA and long lesion length.
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Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Centre, Asan Medical Centre, University of Ulsan College of Medicine, 05505 Olympic-Ro 388-1 Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Centre, Asan Medical Centre, University of Ulsan College of Medicine, 05505 Olympic-Ro 388-1 Seoul, South Korea
| | - Soo-Jin Kang
- Division of Cardiology, Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 05505 Olympic-Ro, 388-1 Seoul, South Korea
| | - Jihoon Kweon
- Department of Convergence Medicine and Biomedical Engineering Research Centre, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - June-Goo Lee
- Department of Convergence Medicine and Biomedical Engineering Research Centre, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 05505 Olympic-Ro, 388-1 Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 05505 Olympic-Ro, 388-1 Seoul, South Korea
| | - Seung Whan Lee
- Division of Cardiology, Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 05505 Olympic-Ro, 388-1 Seoul, South Korea
| | - Cheol Whan Lee
- Division of Cardiology, Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 05505 Olympic-Ro, 388-1 Seoul, South Korea
| | - Seong-Wook Park
- Division of Cardiology, Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 05505 Olympic-Ro, 388-1 Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 05505 Olympic-Ro, 388-1 Seoul, South Korea
| | - Young-Hak Kim
- Division of Cardiology, Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 05505 Olympic-Ro, 388-1 Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Centre, Asan Medical Centre, University of Ulsan College of Medicine, 05505 Olympic-Ro 388-1 Seoul, South Korea
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13
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Fischer AM, van Assen M, Schoepf UJ, Matuskowitz AJ, Varga-Szemes A, Golden JW, Giovagnoli DA, Tesche C, Bayer RR. Non-invasive fractional flow reserve (FFR CT) in the evaluation of acute chest pain - Concepts and first experiences. Eur J Radiol 2021; 138:109633. [PMID: 33735700 DOI: 10.1016/j.ejrad.2021.109633] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 01/26/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate 30 day rate of major adverse cardiac events (MACE) utilizing cCTA and FFRCT for evaluation of patients presenting to the Emergency Department (ED) with acute chest pain. MATERIALS AND METHODS Patients between the ages of 18-95 years who underwent clinically indicated cCTA and FFRCT in the evaluation of acute chest pain in the emergency department were retrospectively evaluated for 30 day MACE, repeat presentation/admission for chest pain, revascularization, and additional testing. RESULTS A total of 59 patients underwent CCTA and subsequent FFRCT for the evaluation of acute chest pain in the ED over the enrollment period. 32 out of 59 patients (54 %) had negative FFRCT (>0.80) out of whom 18 patients (55 %) were discharged from the ED. Out of the 32 patients without functionally significant CAD by FFRCT, 32 patients (100 %) underwent no revascularization and 32 patients (100 %) had no MACE at the 30-day follow-up period. CONCLUSION In this limited retrospective study, patients presenting to the ED with acute chest pain and with CCTA with subsequent FFRCT of >0.8 had no MACE at 30 days; however, for many of these patients results were not available at time of clinical decision making by the ED physician.
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Affiliation(s)
- Andreas M Fischer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Facility Mannheim, Heidelberg University, Heidelberg, Germany
| | - Marly van Assen
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; University Medical Center Groningen, Center for Medical Imaging, Department of Radiology, Groningen, the Netherlands
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Andrew J Matuskowitz
- Division of Emergency Medicine, Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Joseph W Golden
- Division of Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Dante A Giovagnoli
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany; Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
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14
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Varga-Szemes A, Schoepf UJ, Maurovich-Horvat P, Wang R, Xu L, Dargis DM, Emrich T, Buckler AJ. Coronary plaque assessment of Vasodilative capacity by CT angiography effectively estimates fractional flow reserve. Int J Cardiol 2021; 331:307-315. [PMID: 33529657 DOI: 10.1016/j.ijcard.2021.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/15/2021] [Accepted: 01/22/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND To evaluate the feasibility of non-invasive fractional flow reserve (FFR) estimation using histologically-validated assessment of plaque morphology on coronary CTA (CCTA) as inputs to a predictive model further validated against invasive FFR. METHODS Patients (n = 113, 59 ± 8.9 years, 77% male) with suspected coronary artery disease (CAD) who had undergone CCTA and invasive FFR between August 2013 and May 2018 were included. Commercially available software was used to extract quantitative plaque morphology inclusive of both vessel structure and composition. The extracted plaque morphology was then fed as inputs to an optimized artificial neural network to predict lesion-specific ischemia/hemodynamically significant CAD with performance validated by invasive FFR. RESULTS A total of 122 lesions were considered, 59 (48%) had low FFR values. Plaque morphology-based FFR assessment achieved an area under the curve, sensitivity and specificity of 0.94, 0.90 and 0.81, respectively, versus 0.71, 0.71, and 0.50, respectively, for an optimized threshold applied to degree of stenosis. The optimized ridge regression model for continuous value estimation of FFR achieved a cross-correlation coefficient of 0.56 and regression slope of 0.59 using cross validation, versus 0.18 and 0.10 for an optimized threshold applied to degree of stenosis. CONCLUSIONS Our results show that non-invasive plaque morphology-based FFR assessment may be used to predict lesion-specific ischemia resulting in hemodynamically significant CAD. This substantially outperforms degree of stenosis interpretation and has a comparable level of sensitivity and specificity relative to publicly reported results from computational fluid dynamics-based approaches.
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Affiliation(s)
- Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Rui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Danielle M Dargis
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
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Noninvasive Assessment of the Fractional Flow Reserve with the CT FFRc 1D Method: Final Results of a Pilot Study. Glob Heart 2021; 16:1. [PMID: 33598381 PMCID: PMC7792469 DOI: 10.5334/gh.837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Until recently, Russia did not utilize noninvasive fractional flow reserve (FFR) assessment. We developed an automated algorithm for noninvasive assessment of FFR based on a one-dimensional (1D) mathematical modeling. Objective: The research aims to evaluate the diagnostic accuracy of this algorithm. Methods: The study enrolled 80 patients: 16 of them underwent 64-slice computed tomography – included retrospectively, 64 – prospectively, with a 640-slice CT scan. Specialists processed CT images and evaluated noninvasive FFR. Ischemia was confirmed if FFR < 0.80 and disproved if FFR ≥ 0.80. The prospective group of patients was hospitalized for invasive FFR assessment as a reference standard. If ischemic, patients underwent stent implantation. In the retrospective group, patients already had invasive FFR values. Statistical analysis was performed using GraphPad Prism 8. We compared two methods using a Bland–Altman plot and per-vessel ROC curve analysis. Considering the abnormality of distribution by the Kolmogorov-Smirnov test, we have used Spearman’s rank correlation coefficient. Results: During data processing, three patients of the retrospective and 46 patients of the prospective group were excluded. The sensitivity of our method was 66.67% (95% CI: 46.71–82.03); the specificity was 78.95% (95% CI: 56.67–91.49), p = 0.0052, in the per-vessel analysis. In per-patient analysis, the sensitivity was 69.57% (95% CI: 49.13–84.40); the specificity was 87.50% (95% CI: 52.91–99.36), p = 0.0109. The area under the ROC curve in the per-vessel analysis was 77.52% (95% CI: 66.97–88.08), p < 0.0001. Conclusion: The obtained indices of sensitivity, specificity, PPV, and NPV are, in general, comparable to those in other studies. Moreover, the noninvasive values of FFR yielded a high correlation coefficient with the invasive values. However, the AUC was not high enough, 77.52 (95% CI: 66.97–88.08), p < 0.0001. The discrepancy is probably attributed to the initial data heterogeneity and low statistical power.
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Qiao HY, Li JH, Schoepf UJ, Bayer RR, Tinnefeld FC, Di Jiang M, Yang F, Guo BJ, Zhou CS, Ge YQ, Lu MJ, Jiang JW, Lu GM, Zhang LJ. Prognostic implication of CT-FFR based functional SYNTAX score in patients with de novo three-vessel disease. Eur Heart J Cardiovasc Imaging 2020:jeaa256. [PMID: 33184644 DOI: 10.1093/ehjci/jeaa256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/22/2020] [Indexed: 02/01/2023] Open
Abstract
AIMS This study was aimed at investigating whether a machine learning (ML)-based coronary computed tomographic angiography (CCTA) derived fractional flow reserve (CT-FFR) SYNTAX score (SS), 'Functional SYNTAX score' (FSSCTA), would predict clinical outcome in patients with three-vessel coronary artery disease (CAD). METHODS AND RESULTS The SS based on CCTA (SSCTA) and ICA (SSICA) were retrospectively collected in 227 consecutive patients with three-vessel CAD. FSSCTA was calculated by combining the anatomical data with functional data derived from a ML-based CT-FFR assessment. The ability of each score system to predict major adverse cardiac events (MACE) was compared. The difference between revascularization strategies directed by the anatomical SS and FSSCTA was also assessed. Two hundred and twenty-seven patients were divided into two groups according to the SSCTA cut-off value of 22. After determining FSSCTA for each patient, 22.9% of patients (52/227) were reclassified to a low-risk group (FSSCTA ≤ 22). In the low- vs. intermediate-to-high (>22) FSSCTA group, MACE occurred in 3.2% (4/125) vs. 34.3% (35/102), respectively (P < 0.001). The independent predictors of MACE were FSSCTA (OR = 1.21, P = 0.001) and diabetes (OR = 2.35, P = 0.048). FSSCTA demonstrated a better predictive accuracy for MACE compared with SSCTA (AUC: 0.81 vs. 0.75, P = 0.01) and SSICA (0.81 vs. 0.75, P < 0.001). After FSSCTA was revealed, 52 patients initially referred for CABG based on SSCTA would have been changed to PCI. CONCLUSION Recalculating SS by incorporating lesion-specific ischaemia as determined by ML-based CT-FFR is a better predictor of MACE in patients with three-vessel CAD. Additionally, the use of FSSCTA may alter selected revascularization strategies in these patients.
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Affiliation(s)
- Hong Yan Qiao
- Department of Medical Imaging, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210002, China
- Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214041, China
| | - Jian Hua Li
- Department of Cardiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Fiona C Tinnefeld
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Meng Di Jiang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Fei Yang
- Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214041, China
| | - Bang Jun Guo
- Department of Medical Imaging, Jinling Hospital, Medical School of Southern Medical University, Nanjing, Jiangsu 210002, China
| | - Chang Sheng Zhou
- Department of Medical Imaging, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210002, China
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Ying Qian Ge
- CT Scientific Marketing, Siemens Healthcare, Shanghai, China
| | - Meng Jie Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Jian Wei Jiang
- Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214041, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210002, China
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
- Department of Medical Imaging, Jinling Hospital, Medical School of Southern Medical University, Nanjing, Jiangsu 210002, China
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Artificial Intelligence in Cardiac CT: Automated Calcium Scoring and Plaque Analysis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-09549-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Tang CX, Lu MJ, Schoepf JU, Tesche C, Bauer M, Nance J, Griffith P, Lu GM, Zhang LJ. Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve in Patients with Anomalous Origin of the Right Coronary Artery from the Left Coronary Sinus. Korean J Radiol 2020; 21:192-202. [PMID: 31997594 PMCID: PMC6992438 DOI: 10.3348/kjr.2019.0230] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022] Open
Abstract
Objective To examine the fractional flow reserve derived from computed tomographic angiography (CT-FFR) in patients with anomalous origin of the right coronary artery from the left coronary sinus (R-ACAOS) with an interarterial course, assess the relationship of CT-FFR with the anatomical features of interarterial R-ACAOS on coronary computed tomographic angiography (CCTA), and determine its clinical relevance. Materials and Methods Ninety-four patients with interarterial R-ACAOS undergoing CCTA were retrospectively included. Anatomic features (proximal vessel morphology [oval or slit-like], take-off angle, take-off level [below or above the pulmonary valve], take-off type, intramural course, % proximal narrowing area, length of narrowing, minimum luminal area [MLA] at systole and diastole, and vessel compression index) on CCTA associated with CT-FFR ≤ 0.80 were analyzed. Receiver operating characteristic analysis was performed to describe the diagnostic performance of CT-FFR ≤ 0.80 in detecting interarterial R-ACAOS. Results Significant differences were found in proximal vessel morphology, take-off level, intramural course, % proximal narrowing area, and MLA at diastole (all p < 0.05) between the normal and abnormal CT-FFR groups. Take-off level, intramural course, and slit-like ostium (all p < 0.05) predicted hemodynamic abnormality (CT-FFR ≤ 0.80) with accuracies of 0.69, 0.71, and 0.81, respectively. Patients with CT-FFR ≤ 0.80 had a higher prevalence of typical angina (29.4% vs. 7.8%, p = 0.025) and atypical angina (29.4% vs. 6.5%, p = 0.016). Conclusion Take-off level, intramural course, and slit-like ostium were the main predictors of abnormal CT-FFR values. Importantly, patients with abnormal CT-FFR values showed a higher prevalence of typical angina and atypical angina, indicating that CT-FFR is a potential tool to gauge the clinical relevance in patients with interarterial R-ACAOS.
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Affiliation(s)
- Chun Xiang Tang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Meng Jie Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Joseph Uwe Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Maximilian Bauer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - John Nance
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Parkwood Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
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19
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Ischemia and outcome prediction by cardiac CT based machine learning. Int J Cardiovasc Imaging 2020; 36:2429-2439. [DOI: 10.1007/s10554-020-01929-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/26/2020] [Indexed: 12/30/2022]
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20
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Martin SS, Mastrodicasa D, van Assen M, De Cecco CN, Bayer RR, Tesche C, Varga-Szemes A, Fischer AM, Jacobs BE, Sahbaee P, Griffith LP, Matuskowitz AJ, Vogl TJ, Schoepf UJ. Value of Machine Learning-based Coronary CT Fractional Flow Reserve Applied to Triple-Rule-Out CT Angiography in Acute Chest Pain. Radiol Cardiothorac Imaging 2020; 2:e190137. [PMID: 33778579 DOI: 10.1148/ryct.2020190137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/18/2020] [Accepted: 02/17/2020] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the additional value of noninvasive artificial intelligence (AI)-based CT-derived fractional flow reserve (CT FFR), derived from triple-rule-out coronary CT angiography for acute chest pain (ACP) in the emergency department (ED) setting. Materials and Methods AI-based CT FFR from triple-rule-out CT angiography data sets was retrospectively obtained in 159 of 271 eligible patients (102 men; mean age, 57.0 years ± 9.7 [standard deviation]) presenting to the ED with ACP. The agreement between CT FFR (≤ 0.80) and stenosis at triple-rule-out CT angiography (≥ 50%), as well as downstream cardiac diagnostic testing, was investigated. Furthermore, the predictive value of CT FFR for coronary revascularization and major adverse cardiac events (MACE) was assessed over a 1-year follow-up period. Results CT FFR and triple-rule-out CT angiography demonstrated agreement in severity of coronary artery disease (CAD) in 52% (82 of 159) of all cases. CT FFR of 0.80 and less served as a better predictor for coronary revascularization and MACE than stenosis of 50% and greater at triple-rule-out CT angiography (odds ratio, 3.4; 95% confidence interval: 1.4, 8.2 vs odds ratio, 2.2; 95% confidence interval: 0.9, 5.3) (P < .01). In the subgroup of patients with additional noninvasive cardiac testing (94 of 159), there was higher agreement as to the presence or absence of significant disease with CT FFR (55%) than with coronary triple-rule-out CT angiography (47%) (P = .23). Conclusion CT FFR derived from triple-rule-out CT angiography was a better predictor for coronary revascularization and MACE and showed better agreement with additional diagnostic testing than triple-rule-out CT angiography. Therefore, CT FFR may improve the specificity in identifying patients with ACP with significant CAD in the ED setting and reduce unnecessary downstream testing.© RSNA, 2020See also the commentary by Ihdayhid and Ben Zekry in this issue.
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Affiliation(s)
- Simon S Martin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Domenico Mastrodicasa
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Marly van Assen
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Andreas M Fischer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Brian E Jacobs
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Pooyan Sahbaee
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - L Parkwood Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Andrew J Matuskowitz
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - Thomas J Vogl
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260 (S.S.M., D.M., M.v.A., C.N.D.C., R.R.B., C.T., A.V.S., A.M.F., B.E.J., L.P.G., U.J.S.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany (S.S.M., T.J.V.); Stanford University School of Medicine, Department of Radiology, Stanford, Calif (D.M.); Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (C.N.D.C.); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (R.R.B.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (C.T.); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany (C.T.); Siemens Medical Solutions USA, Malvern, Pa (P.S.); and Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC (A.J.M.)
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Hu W, Wu X, Dong D, Cui LB, Jiang M, Zhang J, Wang Y, Wang X, Gao L, Tian J, Cao F. Novel radiomics features from CCTA images for the functional evaluation of significant ischaemic lesions based on the coronary fractional flow reserve score. Int J Cardiovasc Imaging 2020; 36:2039-2050. [DOI: 10.1007/s10554-020-01896-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/21/2020] [Indexed: 04/12/2023]
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Khattak MF, Horne S. The Use of CT Coronary Angiography and CT Fractional Flow Reserve in the Investigation of Patients With Suspected Coronary Artery Disease. Cureus 2020; 12:e7908. [PMID: 32494523 PMCID: PMC7263411 DOI: 10.7759/cureus.7908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To assess the diagnostic performance of CT fractional flow reserve (CT-FFR) and to assess whether its use in addition to CT coronary angiography (CTCA) changed the investigation and management of patients with suspected coronary artery disease (CAD). Method A retrospective case note review was carried out for 200 consecutive patients at Russells Hall Hospital, Dudley, United Kingdom, who had CTCA sent for Heartflow CT-FFR analysis (HeartFlow, Redwood City, CA) between January 2018 and December 2019. Results Patients with CT-FFR > 0.8 were significantly less likely to require further investigation with coronary angiography (p: < 0.00001) than those with CT-FFR < 0.8. The use of CT-FFR significantly reduced need for further functional imaging (6% vs 26%) (p: 0.00012). A total of 15 patients in this study had both a CT-FFR and an invasive FFR measured, with seven (46.66%) of the CT-FFRs correlating with the invasive FFR. Approximately 54% of patients who had a CT-FFR < 0.8 were found to have an invasive FFR of >0.8. Of the 56 patients who underwent coronary angiography, the CT Coronary Artery Disease-Reporting and Data System (CAD-RADS) and angiography CAD-RADS were the same in 66% of the cases with 82% of CT CAD-RADS results being within ±1 of the angiography CAD-RADS. Conclusion The use of CT-FFR alongside CTCA led to a significant reduction in need for coronary angiography and functional testing. Further studies are required to look at the diagnostic accuracy of CT-FFR in direct comparison with invasive FFR.
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23
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Chen M, Wang X, Hao G, Cheng X, Ma C, Guo N, Hu S, Tao Q, Yao F, Hu C. Diagnostic performance of deep learning-based vascular extraction and stenosis detection technique for coronary artery disease. Br J Radiol 2020; 93:20191028. [PMID: 32101464 DOI: 10.1259/bjr.20191028] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the diagnostic performance of deep learning (DL)-based vascular extraction and stenosis detection technology in assessing coronary artery disease (CAD). METHODS The diagnostic performance of DL technology was evaluated by retrospective analysis of coronary computed tomography angiography in 124 suspected CAD patients, using invasive coronary angiography as reference standard. Lumen diameter stenosis ≥50% was considered obstructive, and the diagnostic performances were evaluated at per-patient, per-vessel and per-segment levels. The diagnostic performances between DL model and reader model were compared by the areas under the receiver operating characteristics curves (AUCs). RESULTS In patient-based analysis, AUC of 0.78 was obtained by DL model to detect obstructive CAD [sensitivity of 94%, specificity of 63%, positive predictive value of 94%, and negative predictive value of 59%], While AUC by reader model was 0.74 (sensitivity of 97%, specificity of 50%, positive predictive value of 93%, negative predictive value of 73%). In vessel-based analysis, the AUCs of DL model and reader model were 0.87 and 0.89 respectively. In segment-based analysis, the AUCs of 0.84 and 0.89 were obtained by DL model and reader model respectively. It took 0.47 min to analyze all segments per patient by DL model, which is significantly less than reader model (29.65 min) (p < 0.001). CONCLUSION The DL technology can accurately and effectively identify obstructive CAD, with less time-consuming, and it could be a reliable diagnostic tool to detect CAD. ADVANCES IN KNOWLEDGE The DL technology has valuable prospect with the diagnostic ability to detect CAD.
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Affiliation(s)
- Meng Chen
- Department of Radiology, The First Affiliated Hospital of Soochow University, NO.899 Pinghai Road, Gusu District, Suzhou, Jiangsu, China.,Institute of Medical Imaging, Soochow University, Suzhou, Jiangsu, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, NO.899 Pinghai Road, Gusu District, Suzhou, Jiangsu, China.,Institute of Medical Imaging, Soochow University, Suzhou, Jiangsu, China
| | - Guangyu Hao
- Department of Radiology, The First Affiliated Hospital of Soochow University, NO.899 Pinghai Road, Gusu District, Suzhou, Jiangsu, China.,Institute of Medical Imaging, Soochow University, Suzhou, Jiangsu, China
| | - Xujie Cheng
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chune Ma
- ShuKun (BeiJing) Technology Co., Ltd., Jinhui Bd, Qiyang Rd, Beijing, China
| | - Ning Guo
- ShuKun (BeiJing) Technology Co., Ltd., Jinhui Bd, Qiyang Rd, Beijing, China
| | - Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, NO.899 Pinghai Road, Gusu District, Suzhou, Jiangsu, China.,Institute of Medical Imaging, Soochow University, Suzhou, Jiangsu, China
| | - Qing Tao
- Department of Radiology, The First Affiliated Hospital of Soochow University, NO.899 Pinghai Road, Gusu District, Suzhou, Jiangsu, China.,Institute of Medical Imaging, Soochow University, Suzhou, Jiangsu, China
| | - Feirong Yao
- Department of Radiology, The First Affiliated Hospital of Soochow University, NO.899 Pinghai Road, Gusu District, Suzhou, Jiangsu, China.,Institute of Medical Imaging, Soochow University, Suzhou, Jiangsu, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, NO.899 Pinghai Road, Gusu District, Suzhou, Jiangsu, China.,Institute of Medical Imaging, Soochow University, Suzhou, Jiangsu, China
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24
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Lossnitzer D, Chandra L, Rutsch M, Becher T, Overhoff D, Janssen S, Weiss C, Borggrefe M, Akin I, Pfleger S, Baumann S. Additional Value of Machine-Learning Computed Tomographic Angiography-Based Fractional Flow Reserve Compared to Standard Computed Tomographic Angiography. J Clin Med 2020; 9:jcm9030676. [PMID: 32138259 PMCID: PMC7141259 DOI: 10.3390/jcm9030676] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/13/2020] [Accepted: 02/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Machine-learning-based computed-tomography-derived fractional flow reserve (CT-FFRML) obtains a hemodynamic index in coronary arteries. We examined whether it could reduce the number of invasive coronary angiographies (ICA) showing no obstructive lesions. We further compared CT-FFRML-derived measurements to clinical and CT-derived scores. Methods: We retrospectively selected 88 patients (63 ± 11years, 74% male) with chronic coronary syndrome (CCS) who underwent clinically indicated coronary computed tomography angiography (cCTA) and ICA. cCTA image data were processed with an on-site prototype CT-FFRML software. Results: CT-FFRML revealed an index of >0.80 in coronary vessels of 48 (55%) patients. This finding was corroborated in 45 (94%) patients by ICA, yet three (6%) received revascularization. In patients with an index ≤ 0.80, three (8%) of 40 were identified as false positive. A total of 48 (55%) patients could have been retained from ICA. CT-FFRML (AUC = 0.96, p ≤ 0.0001) demonstrated a higher diagnostic accuracy compared to the pretest probability or CT-derived scores and showed an excellent sensitivity (93%), specificity (94%), positive predictive value (PPV; 93%) and negative predictive value (NPV; 94%). Conclusion: CT-FFRML could be beneficial for clinical practice, as it may identify patients with CAD without hemodynamical significant stenosis, and may thus reduce the rate of ICA without necessity for coronary intervention.
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Affiliation(s)
- Dirk Lossnitzer
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany and ECAS (European Center for Angioscience), Faculty of Medicine Mannheim, Heidelberg University, 68167 Mannheim, Germany; (L.C.); (M.R.); (T.B.); (M.B.); (I.A.); (S.P.); (S.B.)
- Correspondence: ; Tel.: +49-621-383-6695; Fax: +49-621-383-2025
| | - Leonard Chandra
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany and ECAS (European Center for Angioscience), Faculty of Medicine Mannheim, Heidelberg University, 68167 Mannheim, Germany; (L.C.); (M.R.); (T.B.); (M.B.); (I.A.); (S.P.); (S.B.)
| | - Marlon Rutsch
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany and ECAS (European Center for Angioscience), Faculty of Medicine Mannheim, Heidelberg University, 68167 Mannheim, Germany; (L.C.); (M.R.); (T.B.); (M.B.); (I.A.); (S.P.); (S.B.)
| | - Tobias Becher
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany and ECAS (European Center for Angioscience), Faculty of Medicine Mannheim, Heidelberg University, 68167 Mannheim, Germany; (L.C.); (M.R.); (T.B.); (M.B.); (I.A.); (S.P.); (S.B.)
| | - Daniel Overhoff
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, Heidelberg University, 68167 Mannheim, Germany; (D.O.); (S.J.)
| | - Sonja Janssen
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, Heidelberg University, 68167 Mannheim, Germany; (D.O.); (S.J.)
| | - Christel Weiss
- Medical Faculty Mannheim, Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, 68167 Mannheim, Germany;
| | - Martin Borggrefe
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany and ECAS (European Center for Angioscience), Faculty of Medicine Mannheim, Heidelberg University, 68167 Mannheim, Germany; (L.C.); (M.R.); (T.B.); (M.B.); (I.A.); (S.P.); (S.B.)
| | - Ibrahim Akin
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany and ECAS (European Center for Angioscience), Faculty of Medicine Mannheim, Heidelberg University, 68167 Mannheim, Germany; (L.C.); (M.R.); (T.B.); (M.B.); (I.A.); (S.P.); (S.B.)
| | - Stefan Pfleger
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany and ECAS (European Center for Angioscience), Faculty of Medicine Mannheim, Heidelberg University, 68167 Mannheim, Germany; (L.C.); (M.R.); (T.B.); (M.B.); (I.A.); (S.P.); (S.B.)
| | - Stefan Baumann
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany and ECAS (European Center for Angioscience), Faculty of Medicine Mannheim, Heidelberg University, 68167 Mannheim, Germany; (L.C.); (M.R.); (T.B.); (M.B.); (I.A.); (S.P.); (S.B.)
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25
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Machine Learning and Deep Neural Networks Applications in Coronary Flow Assessment. J Thorac Imaging 2020; 35 Suppl 1:S66-S71. [DOI: 10.1097/rti.0000000000000483] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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26
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Schoepf UJ, van Assen M. FFR-CT and CT Myocardial Perfusion Imaging. JACC Cardiovasc Imaging 2019; 12:2472-2474. [DOI: 10.1016/j.jcmg.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 03/14/2019] [Indexed: 11/24/2022]
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27
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Correlation of machine learning computed tomography-based fractional flow reserve with instantaneous wave free ratio to detect hemodynamically significant coronary stenosis. Clin Res Cardiol 2019; 109:735-745. [DOI: 10.1007/s00392-019-01562-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/17/2019] [Indexed: 01/10/2023]
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28
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Schoepf UJ, Gray HN, Tesche C. CT Angiography-derived Fractional Flow Reserve: The Global Game of Thrones. Radiol Cardiothorac Imaging 2019; 1:e190197. [PMID: 33779642 PMCID: PMC7977931 DOI: 10.1148/ryct.2019190197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022]
Affiliation(s)
- U. Joseph Schoepf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Hunter N. Gray
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
| | - Christian Tesche
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260
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29
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Tesche C, Otani K, De Cecco CN, Coenen A, De Geer J, Kruk M, Kim YH, Albrecht MH, Baumann S, Renker M, Bayer RR, Duguay TM, Litwin SE, Varga-Szemes A, Steinberg DH, Yang DH, Kepka C, Persson A, Nieman K, Schoepf UJ. Influence of Coronary Calcium on Diagnostic Performance of Machine Learning CT-FFR: Results From MACHINE Registry. JACC Cardiovasc Imaging 2019; 13:760-770. [PMID: 31422141 DOI: 10.1016/j.jcmg.2019.06.027] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 06/10/2019] [Accepted: 06/19/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study was conducted to investigate the influence of coronary artery calcium (CAC) score on the diagnostic performance of machine-learning-based coronary computed tomography (CT) angiography (cCTA)-derived fractional flow reserve (CT-FFR). BACKGROUND CT-FFR is used reliably to detect lesion-specific ischemia. Novel CT-FFR algorithms using machine-learning artificial intelligence techniques perform fast and require less complex computational fluid dynamics. Yet, influence of CAC score on diagnostic performance of the machine-learning approach has not been investigated. METHODS A total of 482 vessels from 314 patients (age 62.3 ± 9.3 years, 77% male) who underwent cCTA followed by invasive FFR were investigated from the MACHINE (Machine Learning based CT Angiography derived FFR: a Multi-center Registry) registry data. CAC scores were quantified using the Agatston convention. The diagnostic performance of CT-FFR to detect lesion-specific ischemia was assessed across all Agatston score categories (CAC 0, >0 to <100, 100 to <400, and ≥400) on a per-vessel level with invasive FFR as the reference standard. RESULTS The diagnostic accuracy of CT-FFR versus invasive FFR was superior to cCTA alone on a per-vessel level (78% vs. 60%) and per patient level (83% vs. 73%) across all Agatston score categories. No statistically significant differences in the diagnostic accuracy, sensitivity, or specificity of CT-FFR were observed across the categories. CT-FFR showed good discriminatory power in vessels with high Agatston scores (CAC ≥400) and high performance in low-to-intermediate Agatston scores (CAC >0 to <400) with a statistically significant difference in the area under the receiver-operating characteristic curve (AUC) (AUC: 0.71 [95% confidence interval (CI): 0.57 to 0.85] vs. 0.85 [95% CI: 0.82 to 0.89], p = 0.04). CT-FFR showed superior diagnostic value over cCTA in vessels with high Agatston scores (CAC ≥ 400: AUC 0.71 vs. 0.55, p = 0.04) and low-to-intermediate Agatston scores (CAC >0 to <400: AUC 0.86 vs. 0.63, p < 0.001). CONCLUSIONS Machine-learning-based CT-FFR showed superior diagnostic performance over cCTA alone in CAC with a significant difference in the performance of CT-FFR as calcium burden/Agatston calcium score increased. (Machine Learning Based CT Angiography Derived FFR: a Multicenter, Registry [MACHINE] NCT02805621).
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Affiliation(s)
- Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany; Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
| | - Katharina Otani
- Advanced Therapies Innovation Department, Siemens Healthcare K.K., Tokyo, Japan
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Adriaan Coenen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jakob De Geer
- Department of Radiology and Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, CMIV, Linköping University, Linköping, Sweden
| | - Mariusz Kruk
- Coronary Disease and Structural Heart Diseases Department, Invasive Cardiology and Angiology Department, Institute of Cardiology, Warsaw, Poland
| | - Young-Hak Kim
- Department of Cardiology, Heart Institute Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Moritz H Albrecht
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Stefan Baumann
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Matthias Renker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Taylor M Duguay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Sheldon E Litwin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel H Steinberg
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Cezary Kepka
- Coronary Disease and Structural Heart Diseases Department, Invasive Cardiology and Angiology Department, Institute of Cardiology, Warsaw, Poland
| | - Anders Persson
- Department of Radiology and Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, CMIV, Linköping University, Linköping, Sweden
| | - Koen Nieman
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
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30
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Tang CX, Wang YN, Zhou F, Schoepf UJ, Assen MV, Stroud RE, Li JH, Zhang XL, Lu MJ, Zhou CS, Zhang DM, Yi Y, Yan J, Lu GM, Xu L, Zhang LJ. Diagnostic performance of fractional flow reserve derived from coronary CT angiography for detection of lesion-specific ischemia: A multi-center study and meta-analysis. Eur J Radiol 2019; 116:90-97. [DOI: 10.1016/j.ejrad.2019.04.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/03/2019] [Accepted: 04/19/2019] [Indexed: 10/27/2022]
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31
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Devuyst S, Gigase A, Spapen J, Brouwers S, Couck T, Sonck J, Mizukami T, Gigante C, de Raedt H, Schelfaut D, Heggermont W, De Bruyne B, Penicka M, Van Camp G, Collet C. Impact of non-invasive anatomical testing on optimal medical prescription in patients with suspected coronary artery disease. Cardiovasc Diagn Ther 2019; 9:221-228. [PMID: 31275812 PMCID: PMC6603496 DOI: 10.21037/cdt.2019.04.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/04/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Compared to functional testing, coronary computed tomography angiography (CTA) improves clinical outcomes in patients with suspected coronary artery disease (CAD). This is thought to be the result of an increased prescription of preventive medical therapy (statins and aspirin) when relying on a CTA imaging strategy. We compared the rate of statins prescription in a patient cohort assessed either with coronary CTA or exercise testing, and evaluated the agreement on medication prescriptions. METHODS Consecutive patients who underwent coronary CTA and exercise test for suspected CAD were included. Four clinical cardiologists independently analysed each case based on clinical information and the result of either coronary CTA or exercise test. For each case, treatment strategy and prescription were recorded while blinded to the results of the other cardiac test. Treatment strategy was reassessed using the alternative imaging modality three weeks after the first evaluation. RESULTS A total of 113 patients were included. Mean age was 56.7±11.5 years, 52% were males and diabetes were present in 6%. Coronary CTA showed an obstructive epicardial stenosis in 21.4% and any type of atherosclerotic plaque in 54.2%. Functional testing identified ischemia in 9.1%. The use of coronary CTA resulted in higher number of statin (64.9% vs. 44.5%, P<0.001) and aspirin (21.4% vs. 4.3%, P<0.001) prescriptions. There was a substantial agreement on the prescription of statins (mean Cohen's κ coefficient of 0.79±0.07). CONCLUSIONS Epicardial atherosclerotic disease was found in half of patients with suspected CAD as assessed by coronary CTA. Compared to functional testing, coronary CTA evaluation by coronary was associated with an increase in the rate preventive therapy prescription.
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Affiliation(s)
- Stijn Devuyst
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Arno Gigase
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Jerrold Spapen
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Sofie Brouwers
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Thomas Couck
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Carlo Gigante
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Dan Schelfaut
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | | | - Martin Penicka
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
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32
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van Assen M, De Cecco CN, Eid M, von Knebel Doeberitz P, Scarabello M, Lavra F, Bauer MJ, Mastrodicasa D, Duguay TM, Zaki B, Lo GG, Choe YH, Wang Y, Sahbaee P, Tesche C, Oudkerk M, Vliegenthart R, Schoepf UJ. Prognostic value of CT myocardial perfusion imaging and CT-derived fractional flow reserve for major adverse cardiac events in patients with coronary artery disease. J Cardiovasc Comput Tomogr 2019; 13:26-33. [PMID: 30796003 DOI: 10.1016/j.jcct.2019.02.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/11/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The purpose of this study was to analyze the prognostic value of dynamic CT perfusion imaging (CTP) and CT derived fractional flow reserve (CT-FFR) for major adverse cardiac events (MACE). METHODS 81 patients from 4 institutions underwent coronary computed tomography angiography (CCTA) with dynamic CTP imaging and CT-FFR analysis. Patients were followed-up at 6, 12, and 18 months after imaging. MACE were defined as cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, or revascularization. CT-FFR was computed for each major coronary artery using an artificial intelligence-based application. CTP studies were analyzed per vessel territory using an index myocardial blood flow, the ratio between territory and global MBF. The prognostic value of CCTA, CT-FFR, and CTP was investigated with a univariate and multivariate Cox proportional hazards regression model. RESULTS 243 vessels in 81 patients were interrogated by CCTA with CT-FFR and 243 vessel territories (1296 segments) were evaluated with dynamic CTP imaging. Of the 81 patients, 25 (31%) experienced MACE during follow-up. In univariate analysis, a positive index-MBF resulted in the largest risk for MACE (HR 11.4) compared to CCTA (HR 2.6) and CT-FFR (HR 4.6). In multivariate analysis, including clinical factors, CCTA, CT-FFR, and index-MBF, only index-MBF significantly contributed to the risk of MACE (HR 10.1), unlike CCTA (HR 1.2) and CT-FFR (HR 2.2). CONCLUSION Our study provides initial evidence that dynamic CTP alone has the highest prognostic value for MACE compared to CCTA and CT-FFR individually or a combination of the three, independent of clinical risk factors.
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Affiliation(s)
- M van Assen
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, the Netherlands.
| | - C N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Radiology, Emory University, Atlanta, Georgia, USA.
| | - M Eid
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
| | - P von Knebel Doeberitz
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
| | - M Scarabello
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
| | - F Lavra
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
| | - M J Bauer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
| | - D Mastrodicasa
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
| | - T M Duguay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
| | - B Zaki
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
| | - G G Lo
- Department of Diagnostic and Interventional Radiology, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, China.
| | - Y H Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Y Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | | | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.
| | - M Oudkerk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, the Netherlands.
| | - R Vliegenthart
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Departments of Radiology, Groningen, the Netherlands.
| | - U J Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
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The Value of Imaging—The Case for Coronary Computed Tomography Angiography. J Thorac Imaging 2019; 34:2-3. [DOI: 10.1097/rti.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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von Knebel Doeberitz PL, De Cecco CN, Schoepf UJ, Duguay TM, Albrecht MH, van Assen M, Bauer MJ, Savage RH, Pannell JT, De Santis D, Johnson AA, Varga-Szemes A, Bayer RR, Schönberg SO, Nance JW, Tesche C. Coronary CT angiography-derived plaque quantification with artificial intelligence CT fractional flow reserve for the identification of lesion-specific ischemia. Eur Radiol 2018; 29:2378-2387. [PMID: 30523456 DOI: 10.1007/s00330-018-5834-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/29/2018] [Accepted: 10/12/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We sought to investigate the diagnostic performance of coronary CT angiography (cCTA)-derived plaque markers combined with deep machine learning-based fractional flow reserve (CT-FFR) to identify lesion-specific ischemia using invasive FFR as the reference standard. METHODS Eighty-four patients (61 ± 10 years, 65% male) who had undergone cCTA followed by invasive FFR were included in this single-center retrospective, IRB-approved, HIPAA-compliant study. Various plaque markers were derived from cCTA using a semi-automatic software prototype and deep machine learning-based CT-FFR. The discriminatory value of plaque markers and CT-FFR to identify lesion-specific ischemia on a per-vessel basis was evaluated using invasive FFR as the reference standard. RESULTS One hundred three lesion-containing vessels were investigated. 32/103 lesions were hemodynamically significant by invasive FFR. In a multivariate analysis (adjusted for Framingham risk score), the following markers showed predictive value for lesion-specific ischemia (odds ratio [OR]): lesion length (OR 1.15, p = 0.037), non-calcified plaque volume (OR 1.02, p = 0.007), napkin-ring sign (OR 5.97, p = 0.014), and CT-FFR (OR 0.81, p < 0.0001). A receiver operating characteristics analysis showed the benefit of identifying plaque markers over cCTA stenosis grading alone, with AUCs increasing from 0.61 with ≥ 50% stenosis to 0.83 with addition of plaque markers to detect lesion-specific ischemia. Further incremental benefit was realized with the addition of CT-FFR (AUC 0.93). CONCLUSION Coronary CTA-derived plaque markers portend predictive value to identify lesion-specific ischemia when compared to cCTA stenosis grading alone. The addition of CT-FFR to plaque markers shows incremental discriminatory power. KEY POINTS • Coronary CT angiography (cCTA)-derived quantitative plaque markers of atherosclerosis portend high discriminatory power to identify lesion-specific ischemia. • Coronary CT angiography-derived fractional flow reserve (CT-FFR) shows superior diagnostic performance over cCTA alone in detecting lesion-specific ischemia. • A combination of plaque markers with CT-FFR provides incremental discriminatory value for detecting flow-limiting stenosis.
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Affiliation(s)
- Philipp L von Knebel Doeberitz
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. .,Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. .,Heart & Vascular Center, Ashley River Tower, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.
| | - Taylor M Duguay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Moritz H Albrecht
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,Center for Medical Imaging North East Netherlands, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marly van Assen
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Maximilian J Bauer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Rock H Savage
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - J Trent Pannell
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Domenico De Santis
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Rome, Italy
| | - Addison A Johnson
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Richard R Bayer
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Stefan O Schönberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - John W Nance
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
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Artzner C, Daubert M, Ehieli W, Kong D, Mammarappallil J, Nikolaou K, Boll DT, Koweek L. Impact of computed tomography (CT)-derived fractional flow reserve on reader confidence for interpretation of coronary CT angiography. Eur J Radiol 2018; 108:242-248. [DOI: 10.1016/j.ejrad.2018.09.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/18/2018] [Accepted: 09/30/2018] [Indexed: 12/27/2022]
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Asher A, Singhal A, Thornton G, Wragg A, Davies C. FFR CT derived from computed tomography angiography: the experience in the UK. Expert Rev Cardiovasc Ther 2018; 16:919-929. [PMID: 30347174 DOI: 10.1080/14779072.2018.1538786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Non-invasive fractional flow reserve derived from CT coronary angiography (FFRCT) represents a novel technology to investigate coronary artery disease. The application of computational flow dynamics to anatomical data provides the clinician with a further functional assessment to inform decision-making in patients with coronary artery disease. In the UK FFRCT has received medical technology approval for use since February 2017. Areas covered: This article discusses the mathematical and physiological principles underpinning calculation of non-invasive fractional flow reserve (FFR), as well as discussing the differences between the commercially available technologies. Diagnostic accuracy, cost effectiveness and safety of non-invasive FFR from the early clinical trials is examined. Further to this the potential implications of the use of non-invasive FFR in clinical practice in the UK are discussed. Expert commentary: Non-invasive FFR represents a promising comprehensive imaging technology providing both anatomical and physiological data to accurately diagnose obstructive coronary artery disease. The technology has yet to prove to be cost effective in 'real world' cohorts before becoming integrated into everyday clinical practice and guidelines in the United Kingdom.
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Affiliation(s)
- Alex Asher
- a The Royal London Hospital and St Bartholomew's Hospital, London, Barts Health NHS Trust , London , UK
| | - Arvind Singhal
- a The Royal London Hospital and St Bartholomew's Hospital, London, Barts Health NHS Trust , London , UK
| | - George Thornton
- a The Royal London Hospital and St Bartholomew's Hospital, London, Barts Health NHS Trust , London , UK
| | - Andrew Wragg
- a The Royal London Hospital and St Bartholomew's Hospital, London, Barts Health NHS Trust , London , UK
| | - Ceri Davies
- a The Royal London Hospital and St Bartholomew's Hospital, London, Barts Health NHS Trust , London , UK
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Quantitative Imaging and Imaging Biomarkers: The Search for Generalizability in Radiology. J Thorac Imaging 2018; 33:69-70. [PMID: 29461430 DOI: 10.1097/rti.0000000000000321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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