CT Angiography (CTA) and Diagnostic Performance of Noninvasive Fractional Flow Reserve: Results From the Determination of Fractional Flow Reserve by Anatomic CTA (DeFACTO) Study

Leipsic, Jonathon; Yang, Tae Hyun; Thompson, Angus G; Koo, Bon‐Kwon; Mancini, G.B. John; Taylor, Carolyn; Budoff, Matthew J.; Park, Hyung Bok; Berman, Daniel S.; Min, James K.

doi:10.2214/ajr.13.11441

Cited by 132 publications

(68 citation statements)

References 18 publications

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“…This can be accomplished with techniques ranging from ETT 30 (as performed in the SCOT-HEART study) to using various imaging stress tests. Alternatively, an evaluation of ischemia could be performed based on the rest coronary CTA with the estimation of coronary fractional flow reserve by coronary CTA (FFR CT ) 31 or by performing CT myocardial perfusion imaging using vasodilator-induced stress. 32,33 The role of FFR CT as a gatekeeper has recently been evaluated in the Prospective Longitudinal Trial of FFRCT Outcome and Resource Impacts (PLATFORM) trial and was found to effectively reduce the number of candidates referred to ICA by 61%.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes After Evaluation of Stable Chest Pain by Coronary Computed Tomographic Angiography Versus Usual Care

Bittencourt

Hulten

Murthy

et al. 2016

Circ: Cardiovascular Imaging

122

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Background— Limited data exist on how noninvasive testing options compare for evaluating patients with suspected stable coronary artery disease. In this study, we have performed a meta-analysis of randomized controlled trials comparing the use of coronary computed tomographic angiography (CTA) with usual care. Methods and Results— We systematically searched databases for randomized clinical trials comparing coronary CTA with usual care for the evaluation of stable chest pain with follow-up for cardiovascular outcomes. The primary outcomes were myocardial infarction and all-cause mortality. We identified 4 randomized clinical trials, including a total of 7403 patients undergoing coronary CTA and 7414 patients undergoing usual care with various functional testing approaches. When compared with usual care, the use of coronary CTA was associated with a significant reduction in the annual rate of myocardial infarction (rate ratio, 0.69; 95% confidence interval, 0.49–0.98; P =0.038), but no difference was found in all-cause mortality. There was a trend toward more invasive coronary angiographies among patients undergoing coronary CTA (odds ratio, 1.33; 95% confidence interval, 0.95–1.84; P =0.09) and higher use of coronary revascularizations (odds ratio, 1.77; 95% confidence interval, 1.14–2.75). Significant heterogeneity for invasive coronary angiography and revascularization was noted, which was attributable to the Scottish Computed Tomography of the HEART (SCOT-HEART) study. We found no difference in the rate of admission for cardiac chest pain (rate ratio, 1.21; 95% confidence interval, 0.95–1.54). Conclusions— In comparison to usual care, an initial investigation of suspected stable coronary artery disease using coronary CTA resulted in a significant reduction in myocardial infarction, an increased incidence of coronary revascularization, and no effect in all-cause mortality. Future studies should further define whether the potential reduction in myocardial infarction identified justifies the increased resource utilization associated with coronary CTA.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes After Evaluation of Stable Chest Pain by Coronary Computed Tomographic Angiography Versus Usual Care

Bittencourt

Hulten

Murthy

et al. 2016

Circ: Cardiovascular Imaging

122

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“…Accordingly, preliminary data indicate that employing the latest generation of FFR CT computation technology (as used in the NXT trial) and standardized CT image metrics on the DeFACTO CT data set resulted in diagnostic performance of FFR CT comparable to that of the NXT trial [37]. The impact of coronary CTA image quality on the diagnostic performance of both coronary CTA and FFR CT is well established [38][39][40]. The diagnostic performance of coronary CTA and FFR CT have been shown to improve with the adherence to best practice guidelines for image acquisition, particularly regarding heart rate control and use of pre-scan nitroglycerin [39,40].…”

Section: Non-invasive Fractional Flow Reserve-clinical Evidencementioning

confidence: 99%

“…The impact of coronary CTA image quality on the diagnostic performance of both coronary CTA and FFR CT is well established [38][39][40]. The diagnostic performance of coronary CTA and FFR CT have been shown to improve with the adherence to best practice guidelines for image acquisition, particularly regarding heart rate control and use of pre-scan nitroglycerin [39,40]. In contrast to previous trials, strict adherence to these guidelines in the NXT trial was mandatory.…”

Section: Non-invasive Fractional Flow Reserve-clinical Evidencementioning

confidence: 99%

“…These issues can be minimized by adhering to coronary CTA image acquisition guidelines, particularly by the administration of heart rate-lowering medication and sublingual nitrates before image acquisition [37][38][39][40]. As FFR CT computation is based on global coronary and myocardial information, this modality may be inherently less AUC area under curve of the receiver operating characteristics curve, CAD coronary artery disease, CI confidence interval, CTA CT angiography, FFR fractional flow reserve, FFR CT fractional flow reserve calculated from coronary CTA, ICA invasive coronary angiography, PPV positive predictive value, NPV negative predictive value susceptible to single artefacts than coronary CTA.…”

Section: Non-invasive Fractional Flow Reserve-limitationsmentioning

confidence: 99%

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Fractional flow reserve derived from coronary CT angiography in stable coronary disease: a new standard in non-invasive testing?

2015

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Fractional flow reserve (FFR) measured during invasive coronary angiography is the gold standard for lesion-specific decisions on coronary revascularization in patients with stable coronary artery disease (CAD). Current guidelines recommend non-invasive functional or anatomic testing as a gatekeeper to the catheterization laboratory. However, the "holy grail" in non-invasive testing of CAD is to establish a single test that quantifies both coronary lesion severity and the associated ischemia. Most evidence to date of such a test is based on the addition of computational analysis of FFR to the anatomic information obtained from standard-acquired coronary CTA data sets at rest (FFRCT). This review summarizes the clinical evidence for the use of FFRCT in stable CAD in context to the diagnostic performance of other non-invasive testing modalities. Key Points • The process of selecting appropriate patients for invasive coronary angiography is inadequate • Invasive fractional flow reserve is the standard for assessing coronary lesion-specific ischemia • Fractional flow reserve may be derived from standard coronary CT angiography (FFR CT ) • FFR CT provides high diagnostic performance in stable coronary artery disease.

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“…Atualmente, a avaliação de isquemia miocárdica é factível por meio de estudos de FFR (reserva de fluxo coronariano pelo cateterismo) ou nos métodos não invasivos, como a perfusão miocárdica pela ressonância magnética cardíaca, ECO com estresse e cintilografia de perfusão miocárdica com estresse, e recentemente o FFR-CT (DeFACTO Study), que é a avalição da reserva de fluxo coronariano pela tomografia computadorizada 20 .…”

Section: Diagnóstico Da Isquemia Miocárdicaunclassified

Evaluation of Myocardial Ischemia by Multiple Detector Computed Tomography

F¹,

Cury²

2015

Arquivos Brasileiros De Cardiologia - Imagem Cardiovascular

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ResumoHá vários anos as doenças cardiovasculares são a principal causa de morte em todo o mundo, resultando em importante repercussão social e econômica. Diante desse cenário, aumenta a cada dia a busca por um método que seja capaz de diagnosticar a doença arterial coronária de forma precoce e acurada. A angiografia coronária por tomografia computadorizada já está amplamente consolidada para estratificação da doença arterial coronária, e mais recentemente a perfusão miocárdica pela tomografia computadorizada acrescentou informações relevantes ao correlacionar a isquemia com a anatomia coronariana. O objetivo desta revisão é descrever a avaliação de isquemia miocárdica pela tomografia computadorizada com múltiplos detectores. Serão utilizados ensaios clínicos controlados que mostram a possibilidade de um único método identificar a carga de aterosclerose, presença de redução luminal coronária e possível isquemia miocárdica, por meio de um método rápido, prático e seguro, validado por estudo multicêntrico. IntroduçãoAs doenças cardiovasculares são a principal causa de morte em todo o mundo, resultando em importante repercussão social e econômica. Dados da Organização Mundial da Saúde (OMS) indicam que, em 2012, 17,5 milhões de pessoas morreram em todo o mundo vítimas de doenças cardiovasculares (DCV), sendo 7,4 milhões de doença isquêmica do coração e 6,7 milhões de acidente vascular encefálico. Ainda de acordo com a OMS, a doença isquêmica do coração é a principal causa de morte nos países de alta renda e de renda média-baixa, enquanto que nos países de renda média-alta o acidente vascular encefálico (AVE) é a principal causa de morte, seguido da DCV. Já nos países de baixa renda, as doenças respiratórias lideram a lista, seguido de HIV/Aids, enquanto as DCV ocupam a quinta posição 1 .Na atualidade dispomos de vários métodos não invasivos para avaliação da perfusão miocárdica, como o ecodopplercardiograma colorido (ECO), cintilografia de perfusão miocárdica (SPECT), ressonância magnética cardíaca (RMC), e mais recentemente a perfusão miocárdica pela tomografia computadorizada (PMTC).A utilização desses métodos possibilita a estratificação não invasiva da doença arterial coronária (DAC) e o seu diagnóstico funcional, enquanto a associação da anatomia e perfusão pela tomografia computadorizada possibilita um planejamento terapêutico adequado e direcionado para cada grupo de pacientes.A angiografia coronária por tomografia computadorizada (ACTC) permite a detecção de doença arterial coronária significativa com alta sensibilidade e especificidade 2-9 , sendo sua principal indicação descartar redução luminal significativa em pacientes com probabilidade intermediária de DAC 10 . No entanto, a capacidade em identificar as lesões coronarianas que causam isquemia é limitada [11][12][13] ; mas a identificação é de grande importância, pois a revascularização miocárdica está associada a redução da mortalidade e redução dos eventos cardíacos maiores quando a redução luminal coronariana estiver associada a isquemia miocárdica...

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CT Angiography (CTA) and Diagnostic Performance of Noninvasive Fractional Flow Reserve: Results From the Determination of Fractional Flow Reserve by Anatomic CTA (DeFACTO) Study

Abstract: Use of β-blockade and nitroglycerin administration before CT improve diagnostic performance of FFRCT. Diagnostic accuracy of FFRCT is significantly reduced in the setting of misalignment artifacts.

Cited by 132 publications

References 18 publications

Clinical Outcomes After Evaluation of Stable Chest Pain by Coronary Computed Tomographic Angiography Versus Usual Care

Clinical Outcomes After Evaluation of Stable Chest Pain by Coronary Computed Tomographic Angiography Versus Usual Care

Fractional flow reserve derived from coronary CT angiography in stable coronary disease: a new standard in non-invasive testing?

Evaluation of Myocardial Ischemia by Multiple Detector Computed Tomography

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