Diagnostic accuracy of coronary opacification derived from coronary computed tomography angiography to detect ischemia: first validation versus single-photon emission computed tomography

Abstract

BackgroundEstimation of functional relevance of a coronary stenosis by fractional flow reserve (FFR) from coronary computed tomography angiography (CCTA) has recently provided encouraging results. Due to its limited availability, the corrected contrast opacification (CCO) decrease and the transluminal attenuation gradient (TAG) were suggested as less complex alternatives. The aim of the present study was to assess the accuracy of CCO decrease and TAG to predict ischemia as assessed by single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).ResultsThis retrospective study included 72 patients who underwent hybrid CCTA/SPECT MPI with at least one coronary artery stenosis. Of 127 vessels with a coronary stenosis in CCTA, 38 (30%) were causing ischemia in its subtending myocardium. The area under the curve (AUC) for CCO decrease to predict ischemia was 0.707 with sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 74, 64, 85, 47, and 67%, respectively. For TAG, the AUC was 0.469.ConclusionsCCTA-derived CCO decrease but not TAG predicts ischemia in SPECT MPI. The negative predictive value of CCO decrease of 85% may confer clinical implications in the diagnostic work-up of patients with a coronary stenosis.

Coronary CT angiography–derived plaque quantification with artificial intelligence CT fractional flow reserve for the identification of lesion-specific ischemia

“…Likewise, Iguchi et al [27] identified lesion length as a valuable predictor of significant coronary stenosis, which was confirmed in our study (lesion length: OR 1.15, p = 0.037). Furthermore, recent studies by Dey et al [28] and Benz et al [29] identified contrast density difference as the strongest marker for the prediction of lesionspecific ischemia. However, in the present study, contrast density was not evaluated, which might explain the difference in AUCs between the combination of plaque markers (AUC 0.83) and deep machine learning-based CT-FFR (AUC 0.93).…”

The value of coronary computed tomography angiography in assessing the cardiac circulation of an outpatient-based population

“…However, in this study, CCTA was performed at rest and revealed that the flow at rest might indicate the hemodynamic relevance of coronary lesions, which was consistent with the findings of other scholars. [ 26 , 27 ] These views suggest that measurement of the flow at rest may indicate possible pathological changes following inadequate adaptation.…”

Fractional flow reserve as the standard of reference: All that glistens is not gold

“…16 Thanks to significant reduction in radiation exposure from coronary CT angiography, [25][26][27] coronary lesions of younger and healthier patients are now being tested by CT-FFR or other CT-derived measurements. [28][29][30] As a consequence, the interaction between lesion-specific ischemia and myocardial blood flow warrants further investigation to prevent overestimation of coronary lesions.…”