Diagnosing coronary artery disease after a positive coronary computed tomography angiography: the Dan-NICAD open label, parallel, head to head, randomized controlled diagnostic accuracy trial of cardiovascular magnetic resonance and myocardial perfusion scintigraphy

Nissen, Louise; Winther, Simon; Westra, Jelmer; Ejlersen, June Anita; Isaksen, Christin; Rossi, Alexia; Holm, Niels Ramsing; Urbonavičienė, Gražina; Gormsen, Lars Christian; Madsen, Lene Helleskov; Christiansen, Evald Høj; Mæng, Michael; Knudsen, Lars; Frost, Lars; Brix, Lau; Bøtker, Hans Erik; Petersen, Steffen E.; Bøttcher, Morten

doi:10.1093/ehjci/jex342

Cited by 57 publications

(54 citation statements)

References 24 publications

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“…For CMR, an abnormal scan was defined as subendocardial or transmural changes by stress imaging or irreversible defects in ≥ 2 contiguous segments by late gadolinium enhancement imaging. Full description of MPS and CMR analysis was reported in the Dan-NICAD papers [14,15]. CMR core-lab readings were performed in an experienced core lab (William Harvey Research Institute, Queen Mary University of London, London, UK) while MPS Images were analyzed by a different independent core lab (Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark).…”

Section: Non-invasive Imagingmentioning

confidence: 99%

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Comparison of quantitative flow ratio and fractional flow reserve with myocardial perfusion scintigraphy and cardiovascular magnetic resonance as reference standard. A Dan-NICAD substudy

Sejr-Hansen

Winther

et al. 2019

Int J Cardiovasc Imaging

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Quantitative flow ratio (QFR) and fractional flow reserve (FFR) have not yet been compared head to head with perfusion imaging as reference for myocardial ischemia. We aimed to compare the diagnostic accuracy of QFR and FFR with myocardial perfusion scintigraphy (MPS) or cardiovascular magnetic resonance (CMR) as reference. This study is a predefined post hoc analysis of the Dan-NICAD study (NCT02264717). Patients with suspected coronary artery disease by coronary computed tomography angiography (CCTA) were randomized 1:1 to MPS or CMR and were referred to invasive coronary angiography with FFR and predefined QFR assessment. Paired data with FFR, QFR and MPS or CMR were available for 232 vessels with stenosis in 176 patients. Perfusion defects were detected in 57 vessel territories (25%). For QFR and FFR the diagnostic accuracy was 61% and 57% (p = 0.18) and area under the receiver operating curve was 0.64 vs. 0.58 (p = 0.22). Stenoses with absolute indication for stenting due to diameter stenosis > 90% by visual estimate were not classified as significant by either QFR or MPS/CMR in 21% (7 of 34) of cases. The diagnostic performance of QFR and FFR was similar but modest with MPS or CMR as reference. Comparable performance levels for QFR and FFR are encouraging for this pressure wire-free diagnostic method. Keywords Quantitative flow ratio • Fractional flow reserve • Myocardial perfusion scintigraphy • Cardiovascular magnetic resonance • Stable angina • Myocardial ischemia Martin Sejr-Hansen and Jelmer Westra equally contributed.

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Section: Non-invasive Imagingmentioning

confidence: 99%

“…Remaining segments were defined as distal. We refer to the Dan-NICAD papers for further details [14,15].…”

Section: Invasive Coronary Angiography and Fractional Flow Reservementioning

confidence: 99%

Comparison of quantitative flow ratio and fractional flow reserve with myocardial perfusion scintigraphy and cardiovascular magnetic resonance as reference standard. A Dan-NICAD substudy

Sejr-Hansen

Winther

et al. 2019

Int J Cardiovasc Imaging

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“…In fact, only two-thirds of the patients to whom revascularization was exposure. [25][26][27] FFRCT may provide advantages in each of these areas, because of its accuracy 6-8 and elimination of additional visits and radiation exposure. Our analysis demonstrated that the proportion of patients deemed to require additional testing in Japan, at nearly 45% following the initial assessment by cCTA, was reduced to nearly zero (0.02%) after FFRCT analysis.…”

Section: Ffrct Reduced Additional Testing and Stratified Patientsmentioning

confidence: 99%

Clinical Impact of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Japanese Population in the ADVANCE Registry

Shiono

Matsuo

Kawasaki

et al. 2019

Circ J

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tional guidelines strongly endorse invasive FFR in the management of CAD patients. 4 However, the adoption of FFR is limited in the real world and its invasive nature is thought to be a major hindrance to its use. 5 Coronary computed tomography angiography (cCTA)-P hysiological assessment is paramount in the management of patients with coronary artery disease (CAD). Invasive fractional flow reserve (FFR) has proven to have excellent diagnostic accuracy and to improve the clinical outcome. 1-3 As a result, the interna

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“…Indeed, the three false-negative cases in predicting FFR less than or equal to 0.8 all involved patients who did not respond to adenosine. Together, both provide a clue to the low diagnostic value of uncorrected perfusion MRI for FFR-defined myocardial ischemia, as reported in a recent trial [25], and indicate that relative perfusion index is the parameter with the greatest ability to control the confounders and the discrepancies between perfusion MRI and FFR-defined ischemia [17].…”

Section: Discussionmentioning

confidence: 95%

Value of Relative Myocardial Perfusion at MRI for Fractional Flow Reserve–Defined Ischemia: A Pilot Study

Ghekiere

Dacher

Dewilde

et al. 2019

American Journal of Roentgenology

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Diagnosing coronary artery disease after a positive coronary computed tomography angiography: the Dan-NICAD open label, parallel, head to head, randomized controlled diagnostic accuracy trial of cardiovascular magnetic resonance and myocardial perfusion scintigraphy

Abstract: Patients with low/intermediate CAD risk and a positive CCTA scan represent a challenge to perfusion techniques indicated by the low sensitivity of both CMR and MPS with FFR as a reference. The mechanisms underlying this discrepancy need further investigation.

Cited by 57 publications

References 24 publications

Comparison of quantitative flow ratio and fractional flow reserve with myocardial perfusion scintigraphy and cardiovascular magnetic resonance as reference standard. A Dan-NICAD substudy

Comparison of quantitative flow ratio and fractional flow reserve with myocardial perfusion scintigraphy and cardiovascular magnetic resonance as reference standard. A Dan-NICAD substudy

Clinical Impact of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Japanese Population in the ADVANCE Registry

Value of Relative Myocardial Perfusion at MRI for Fractional Flow Reserve–Defined Ischemia: A Pilot Study

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