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Van Diemen PAA, Driessen RS, Kooistra RA, Stuijfzand WJ, Raijmakers PG, Schumacher SP, Bom MJ, Everaars H, Min JK, Leipsic JA, Knuuti J, Underwood SR, Van Rossum AC, Danad I, Knaapen P. 1268A comparison between the diagnostic performance of quantitative flow ratio and non-invasive imaging modalities for diagnosing myocardial ischemia defined by FFR, a PACIFIC-trial interim analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Quantitative flow ratio (QFR) uses fast computational algorithms based on 3-dimensional quantitative coronary angiography and estimation of contrast flow velocity during invasive coronary angiography (ICA) to obtain QFR values equivalent to fractional flow reserve (FFR).
Objective
To compare the diagnostic performance of QFR with coronary computed tomography angiography (CCTA), single-photon emission tomography (SPECT), and positron emission tomography (PET) for diagnosing myocardial ischemia defined by FFR.
Method
QFR computation was attempted in 109 patients (286 vessels without a subtotal/total lesion) of the 208 patients included in the PACIFIC-trial. Patients underwent 256-slice CCTA, Tetrofosmin SPECT, and [15O]H2O PET prior to ICA in conjunction with 3 vessel FFR measurements. ICA images were obtained without the use of a dedicated QFR acquistion protocol. QFR was calculated using a fixed empiric hyperemic flow velocity (fQFR) as well as using a patient specific flow velocity based on contrast passage through the coronary (cQFR). All analysis were performed on a per vessel level.
Results
Fixed QFR computation succeeded in 152 (53%) vessels while cQFR analysis was successful in 140 (49%) vessels. A good correlation between FFR and fQFR/cQFR was observed (R=0.774, p<0.001/R=0.790, p<0.001). The diagnostic performance in terms of sensitivity, specificity, negative predictive value, positive predictive value, and accuracy is presented in table 1. In total, 133 vessels with matched FFR, fQFR, cQFR, CCTA, SPECT, and PET results were available for the comparative C-statistic analysis, figure 1. The diagnostic performance of fQFR and cQFR was comparable (p=0.451) and superior to CCTA (p=0.004/p=0.003), SPECT (p<0.001/p<0.001), and PET (p=0.008/p=0.006), figure 1. CCTA, and PET performed alike (p=0.568) and outperformed SPECT (p=0.023, p=0.002).
Table 1 % (95% Confidence Interval) fQFR n=152 cQFR (n=140) CCTA (n=152) SPECT (n=150) PET (n=149) Sensitivity 76 (59–89) 71 (53–86) 70 (51–84) 30 (16–49) 76 (58–89) Specificity 94 (88–98) 93 (86–97) 73 (64–81) 96 (90–99) 80 (72–87) Negative Predictive Value 93 (88–96) 92 (86–95) 90 (84–94) 83 (79–86) 92 (86–96) Positive Predictive Value 79 (64–89) 74 (59–85) 42 (33–51) 67 (42–84) 52 (42–62) Accuracy 90 (84–94) 88 (81–93) 72 (65–79) 81 (74–87) 79 (72–85)
Figure 1.
Conclusion
Fixed QFR and cQFR correlate well with FFR with a high diagnostic accuracy as result. QFR outperformed CCTA, SPECT, and PET for the diagnosis of myocardial ischemia on a per vessel basis with the important footnote that fQFR and cQFR could only be computed in 53%, and 49% of the vessels.
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Affiliation(s)
- P A A Van Diemen
- Amsterdam UMC, Location VU University Medical Center, Amsterdam, Netherlands (The)
| | - R S Driessen
- Amsterdam UMC, Location VU University Medical Center, Amsterdam, Netherlands (The)
| | - R A Kooistra
- Medis Medical Imaging Systems, Leiden, Netherlands (The)
| | - W J Stuijfzand
- Amsterdam UMC, Location VU University Medical Center, Amsterdam, Netherlands (The)
| | - P G Raijmakers
- Amsterdam UMC, Location VU University Medical Center, Amsterdam, Netherlands (The)
| | - S P Schumacher
- Amsterdam UMC, Location VU University Medical Center, Amsterdam, Netherlands (The)
| | - M J Bom
- Amsterdam UMC, Location VU University Medical Center, Amsterdam, Netherlands (The)
| | - H Everaars
- Amsterdam UMC, Location VU University Medical Center, Amsterdam, Netherlands (The)
| | - J K Min
- Weill Cornell Medical College, Cardiovascular Imaging, New York, United States of America
| | - J A Leipsic
- University of British Columbia, Medicine and Radiology, Vancouver, Canada
| | - J Knuuti
- Turku University Hospital, PET centre, Turku, Finland
| | - S R Underwood
- Royal Brompton Hospital, Nuclear Medicine, London, United Kingdom
| | - A C Van Rossum
- Amsterdam UMC, Location VU University Medical Center, Amsterdam, Netherlands (The)
| | - I Danad
- Amsterdam UMC, Location VU University Medical Center, Amsterdam, Netherlands (The)
| | - P Knaapen
- Amsterdam UMC, Location VU University Medical Center, Amsterdam, Netherlands (The)
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van Es S, Kooistra RA, Schaap P. Two ras genes in Dictyostelium minutum show high sequence homology, but different developmental regulation from Dictyostelium discoideum rasD and rasG genes. Gene 1997; 187:93-7. [PMID: 9073071 DOI: 10.1016/s0378-1119(96)00729-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The social amoeba Dictyostelium discoideum expresses five ras genes at different stages of development. One of them, DdrasD is expressed during postaggregative development and transcription is induced by extracellular cAMP. A homologue of DdrasD, the DdrasG gene, is expressed exclusively during vegetative growth. We cloned two ras homologues Dmras1 and Dmras2 from the primitive species D. minutum, which show high homology to DdrasD and DdrasG and less homology to the other Ddras genes. In contrast to the DdrasD and DdrasG genes, both the Dmras1 and Dmras2 genes are expressed during the entire course of development. The expression levels are low during growth, increase at the onset of starvation and do not decrease until fruiting bodies have formed. Expression of neither Dmras1 or Dmras2 is regulated by cAMP. So even though the high degree of homology between the ras genes of different species suggests conservation of function, this function is apparently not associated with a specific developmental stage.
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Affiliation(s)
- S van Es
- Institute for Molecular Plant Sciences, University of Leiden, Wassenaarseweg, The Netherlands
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