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- Title
The diagnostic performance of quantitative flow ratio and perfusion imaging in patients with prior coronary artery disease.
- Authors
Diemen, Pepijn A van; Winter, Ruben W de; Schumacher, Stefan P; Everaars, Henk; Bom, Michiel J; Jukema, Ruurt A; Somsen, Yvemarie B; Raijmakers, Pieter G; Kooistra, Rolf A; Timmer, Janny; Maaniitty, Teemu; Robbers, Lourens F; Bartheld, Martin B von; Demirkiran, Ahmet; Rossum, Albert C van; Reiber, Johan H; Knuuti, Juhani; Underwood, S Richard; Nagel, Eike; Knaapen, Paul
- Abstract
Aims In chronic coronary syndrome (CCS) patients with documented coronary artery disease (CAD), ischaemia detection by myocardial perfusion imaging (MPI) and an invasive approach are viable diagnostic strategies. We compared the diagnostic performance of quantitative flow ratio (QFR) with single-photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance imaging (CMR) in patients with prior CAD [previous percutaneous coronary intervention (PCI) and/or myocardial infarction (MI)]. Methods and results This PACIFIC-2 sub-study evaluated 189 CCS patients with prior CAD for inclusion. Patients underwent SPECT, PET, and CMR followed by invasive coronary angiography with fractional flow reserve (FFR) measurements of all major coronary arteries (N = 567), except for vessels with a sub-total or chronic total occlusion. Quantitative flow ratio computation was attempted in 488 (86%) vessels with measured FFR available (FFR ≤0.80 defined haemodynamically significant CAD). Quantitative flow ratio analysis was successful in 334 (68%) vessels among 166 patients and demonstrated a higher accuracy (84%) and sensitivity (72%) compared with SPECT (66%, P < 0.001 and 46%, P = 0.001), PET (65%, P < 0.001 and 58%, P = 0.032), and CMR (72%, P < 0.001 and 33%, P < 0.001). The specificity of QFR (87%) was similar to that of CMR (83%, P = 0.123) but higher than that of SPECT (71%, P < 0.001) and PET (67%, P < 0.001). Lastly, QFR exhibited a higher area under the receiver operating characteristic curve (0.89) than SPECT (0.57, P < 0.001), PET (0.66, P < 0.001), and CMR (0.60, P < 0.001). Conclusion QFR correlated better with FFR in patients with prior CAD than MPI, as reflected in the higher diagnostic performance measures for detecting FFR-defined, vessel-specific, significant CAD.
- Subjects
STATISTICS; RESEARCH; PERCUTANEOUS coronary intervention; CONFIDENCE intervals; OPERATIVE surgery; MAGNETIC resonance imaging; MYOCARDIAL infarction; RETROSPECTIVE studies; COMPARATIVE studies; CORONARY artery disease; POSITRON emission tomography; DESCRIPTIVE statistics; INTRACLASS correlation; PERFUSION imaging; DATA analysis software; DATA analysis; PERFUSION; CARDIAC-gated SPECT
- Publication
European Heart Journal - Cardiovascular Imaging, 2024, Vol 25, Issue 1, p116
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jead197