Comparison of Coronary Computed Tomography Angiography, Fractional Flow Reserve, and Perfusion Imaging for Ischemia Diagnosis

Driessen, Roel; Danad, Ibrahim; Stuijfzand, Wijnand J.; Raijmakers, Pieter; Schumacher, Stefan; Diemen, Pepijn A. van; Leipsic, Jonathon; Knuuti, Juhani; Underwood, S. Richard; Ven, Peter M. van de; Rossum, Albert C. van; Taylor, Charles A.; Knaapen, Paul

doi:10.1016/j.jacc.2018.10.056

Cited by 287 publications

(171 citation statements)

References 25 publications

Supporting

Mentioning

166

Contrasting

Unclassified

Order By: Relevance

“…Accordingly, in vessels that have been assessed using both techniques, if the measurement locations of invasive FFR and FFR CT are not matched, their values can be different and may not closely correlate. significant and that the patient can be safely treated with optimal medical treatment without further downstream testing (1,(12)(13)(14)(15)(16)(17)(18)22,23). A poststenotic FFR CT value less than or equal to 0.80 indicates the possibility of hemodynamic significance (1,(15)(16)(17)(18).…”

Section: Ffr Versus Ffr Ctmentioning

confidence: 99%

“…significant and that the patient can be safely treated with optimal medical treatment without further downstream testing (1,(12)(13)(14)(15)(16)(17)(18)22,23). A poststenotic FFR CT value less than or equal to 0.80 indicates the possibility of hemodynamic significance (1,(15)(16)(17)(18). The use of this dichotomous FFR CT threshold to guide treatment decisions, namely to avoid further downstream testing or consider invasive angiography and revascularization, remains controversial, as it is well known from the invasive literature that the greatest benefit of revascularization is obtained in patients with the most severe pressure loss (24,25).…”

Section: Ffr Versus Ffr Ctmentioning

confidence: 99%

“…Several factors support this strategy. First, FFR CT values are lower than measured FFR (with a bias ranging between 0.03 and 0.05) (16,18). Second, among patients with FFR CT values less than or equal to 0.80, there is a graded correlation between FFR CT and invasive FFR, with the highest FFR CT uncertainty in the range between 0.76 and 0.80 and the highest agreement when FFR CT is less than or equal to 0.75 (12,18).…”

Section: Ffr Versus Ffr Ctmentioning

confidence: 99%

“…FFR CT assessment is increasingly used in mainstream clinical practice (9)(10)(11)(12)(13)(14) and is likely to further expand with the increased utilization of coronary CT angiography as a first-line test in patients suspected of having coronary artery disease (CAD). While there has been much focus on the diagnostic performance and potential clinical utility of FFR CT in patients with moderate CAD (9)(10)(11)(12)(13)(14)(15)(16)(17)(18), there has been less focus on interpretation, reporting, and integration of FFR CT results into routine clinical practice (19). A broadly adopted standardized FFR CT interpretation and reporting approach providing rich and consistent information may facilitate more appropriate clinical implementation and stimulate further high-quality research.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Coronary CT Angiography-derived Fractional Flow Reserve Testing in Patients with Stable Coronary Artery Disease: Recommendations on Interpretation and Reporting

Nørgaard¹,

Fairbairn²,

Safian³

et al. 2019

Radiology: Cardiothoracic Imaging

View full text Add to dashboard Cite

Noninvasive fractional flow reserve derived from coronary CT angiography (FFR CT ) is increasingly used in patients with coronary artery disease as a gatekeeper to the catheterization laboratory. While there is emerging evidence of the clinical benefit of FFR CT in patients with moderate coronary disease as determined with coronary CT angiography, there has been less focus on interpretation, reporting, and integration of FFR CT results into routine clinical practice. Because FFR CT analysis provides a plethora of information regarding pressure and flow across the entire coronary tree, standardized criteria on interpretation and reporting of the FFR CT analysis result are of crucial importance both in context of the clinical adoption and in future research. This report represents expert opinion and recommendation on a standardized FFR CT interpretation and reporting approach.Published under a CC BY 4.0 license.

show abstract

Section: Ffr Versus Ffr Ctmentioning

confidence: 99%

Section: Ffr Versus Ffr Ctmentioning

confidence: 99%

Section: Ffr Versus Ffr Ctmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Coronary CT Angiography-derived Fractional Flow Reserve Testing in Patients with Stable Coronary Artery Disease: Recommendations on Interpretation and Reporting

Nørgaard¹,

Fairbairn²,

Safian³

et al. 2019

Radiology: Cardiothoracic Imaging

View full text Add to dashboard Cite

show abstract

“…The robust flow visualization and semi-quantitative assessment favors PET as useful tool for ''staging'' CAD, especially by PET/CTA. 14 The high spatial resolution and accurate estimate of infarct size supports the use of MRI. The drawback of MR technology for cardiac imaging currently is the lack of robust and diagnostic coronary angiography.…”

mentioning

confidence: 96%

What did we learn from PET/MR?

Schwaiger

Nekolla

2020

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

In this JNC issue, Dr. Autio and his colleagues introduce 68 Ga-DOTA chelate as new tracer for the delineation of myocardial perfusion as well as extracellular space in a rodent infarct model. This application has most likely been triggered by the fact that gadolinium chelates are widely being used as contrast agent in magnetic resonance imaging (MRI). In cardiac MRI (CMRI), the use of Gd-chelates represents an established technology for the work-up of patients with coronary artery disease. Quite interestingly, this class of MR contrast agents was modeled in the 1980s after a tracer principle in nuclear medicine-99m Tc-DTPA. 1 The advantages of MRI in terms of high spatial resolution and lack of ionizing radiation have supported the clinical application of Gd-chelates for the imaging of myocardial perfusion, the delineation of myocardial scar as well as-in more general terms-for the detection of alterations in extracellular volume. 2-4 However, there have been questions about the possible toxicity of these contrast agents as gadolinium deposits were found in brain tissue. 5 Nevertheless, the technology remains a standard procedure in many cardiovascular imaging centers. Based on this positive experience, it is not surprising that using 68 Ga-labelled chelates in combination with dynamic PET acquisition allows a replication of data established in the MR community. The sophisticated first-pass analysis established at the laboratory of the Turku investigators, mainly using 15 Owater as the PET tracer, allows an almost automatic quantitative analysis yielding absolute measurements of myocardial perfusion as shown in many publications. 6 The group at the University of Turku has already demonstrated that PET 15 O-water studies in the normal flow range correlate with the perfusion results obtained after the intravenous bolus injection of 68 Ga-DOTA. 7 The paper by Dr. Autio et al raises an important question: What are the relative advantages of PET vs MR imaging for extracting biological information such as myocardial perfusion, extracellular space and myocardial infarct extension? For the clinical work-up of patients with suspected coronary artery disease the need for an accurate and robust assessment of myocardial perfusion and coronary flow reserve has been recognized for decades. 8 Currently, the most commonly used PET tracer is rubidium-82 ( 82 Rb) because it is generator-used and allows rapid evaluation of rest and stress perfusion due to its short physical half-life of 76 seconds. 9 In the scientific community, 13 N-ammonia has gained acceptance since it has a high myocardial extraction coupled with a suitable physical half-life of 10 minutes to provide excellent image quality due to the high-tracer retention. 10 The drawback of 13 N-ammonia is the need of an onsite cyclotron, which limits the use to primarily academic institutions. The same applies to 15 O-water, which represents a freely diffusible used for cerebral and myocardial perfusion measurements.Many publications have indicated that with both 15 O-water...

show abstract

Validating Deep Learning to Distinguish Takotsubo Syndrome From Acute Myocardial Infarction—Beware of Shortcuts, Human Supervision Required

Wehbe

Thomas

2022

JAMA Cardiol

View full text Add to dashboard Cite

Artificial intelligence, particularly deep learning (DL), is poised to transform the field of cardiovascular imaging. While still a relatively young discipline, there has been an explosion of research in DL for cardiovascular imaging as investigators seek to build systems designed to segment cardiac chambers, automate functional assessment, detect disease states, and predict prognosis-all using raw imaging data. [1][2][3] Innovative systems have been designed to guide a novice to obtain diagnostic bedside cardiac ultrasonography 4 or noninvasively estimate fractional flow reserve on coronary computed tomography angiography (CCTA). 5 Such is the promise of DL, a powerful technology that requires little input from humans in the training/development process and often produces highly accurate results. However, this human input is vital for ensuring valid, unbiased, and generalizable model outputs.

show abstract

Comparison of Coronary Computed Tomography Angiography, Fractional Flow Reserve, and Perfusion Imaging for Ischemia Diagnosis

Cited by 287 publications

References 25 publications

Coronary CT Angiography-derived Fractional Flow Reserve Testing in Patients with Stable Coronary Artery Disease: Recommendations on Interpretation and Reporting

Coronary CT Angiography-derived Fractional Flow Reserve Testing in Patients with Stable Coronary Artery Disease: Recommendations on Interpretation and Reporting

What did we learn from PET/MR?

Validating Deep Learning to Distinguish Takotsubo Syndrome From Acute Myocardial Infarction—Beware of Shortcuts, Human Supervision Required

Contact Info

Product

Resources

About