Diagnostic and Clinical Value of FFRCT in Stable Chest Pain Patients With Extensive Coronary Calcification

Mickley, Hans; Veien, Karsten Tange; Gerke, Oke; Lambrechtsen, Jess; Rohold, Allan; Steffensen, Flemming Hald; Husic, Mirza; Akkan, Dilek; Busk, Martin; Jessen, Louise Brügmann; Jensen, Lisette Okkels; Diederichsen, Axel Cosmus Pyndt; Øvrehus, Kristian Altern

doi:10.1016/j.jcmg.2021.12.010

Cited by 28 publications

(11 citation statements)

References 37 publications

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“…The mean overall Agatston Score in our study was 330.2 ± 488.8. Mickley H et al already showed that most patients with an Agatston Score > 399 had at least one stenosis with a cFFR ≤ 0.80 39 . Tesche et al showed also a high performance in low-to-intermediate Agatston scores (0 to 400) with a statistically significant difference (AUC 0.71 vs. 0.85, p = 0.04) 40 .…”

Section: Discussionmentioning

confidence: 99%

On-site CT-derived cFFR in patients with suspected coronary artery disease: Feasibility on a 128-row CT scanner in everyday clinical practice

Baumeister,

Kloth,

Schmidt

et al. 2023

Rofo

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Purpose Technical feasibility of CT-based calculation of fractional flow reserve (cFFR) using a 128-row computed tomography scanner in an everyday routine setting. Post-processing and everyday practicability should be analyzed on the scanner on-site in connection with clinical parameters. Materials and Methods This single-center retrospective analysis included 230 patients (74 female; mean age 63.8 years) with CCTA within 21 months between 01/2018 and 09/2019 without non-pathological examinations. cFFR values were obtained using a deep learning-based non-commercial research prototype (cFFR Version3.5.0; Siemens Healthineers GmbH, Erlangen). cFFR values were evaluated at two points: at the maximum point of the stenosis and 1.0 cm distal to the stenosis. Comparison with invasive coronary angiography in 57/230 patients (24.7 %) was performed. CT parameters and quality were evaluated. Further subgroup classification concerning criteria of technical postprocessing was performed: no changes necessary, minor corrections necessary, major corrections necessary, and no evaluation was possible. The required time from starting the software to the final result was evaluated. Results A total of 116/448 (25.9 %) mild, 223/448 (49.8 %) moderate, and 109/448 (24.3 %) obstructive stenoses was found. The mean cFFR at the maximum point of the stenosis was 0.92 ± 0.09 and significantly higher than the cFRR value of 0.89 ± 0.13 distal to the stenosis (p < 0.001*). The mean degree of stenosis was 44.02 ± 26.99 % (range: 1–99 %) with an area of 5.39 ± 3.30 mm2. In a total of 45 patients (19.1 %), a relevant reduction in cFFR below 0.80 was determined. Overall, in 57/230 patients (24.8 %), catheter angiography was performed. No significant difference in the degree of maximal stenosis (CAD-RADS 0–2/3/4) was detected between the classification of CCTA and ICA (p = 0.171). The mean post-processing time varied significantly with 8.34 ± 4.66 min. in single-vessel CAD vs. 12.91 ± 3.92 min. in two-vessel CAD vs. 21.80 ± 5.94 min. in three-vessel CAD (each p < 0.001). Conclusion Noninvasive onsite quantification of cFFR is feasible with minimal observer interaction in a routine real-world setting on a 128-row scanner. Deep learning-based algorithms allow a robust and semi-automatic on-site determination of cFFR based on data from standard CT scanners. Key Points:

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Section: Discussionmentioning

confidence: 99%

On-site CT-derived cFFR in patients with suspected coronary artery disease: Feasibility on a 128-row CT scanner in everyday clinical practice

Baumeister,

Kloth,

Schmidt

et al. 2023

Rofo

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“…The authors pointed to an increasing relative risk of major cardiovascular events for patients with Agatston scores classified as 100–400, 401–999, and 1000 or more, compared to patients with an Agatston score of zero. Mickley et al [ 62 ] investigated the diagnostic and short-term role of coronary computed tomography angiography-derived fractional flow reserve (FFR CT ) in chest pain patients with an Agatston score exceeding 399, and Diederichsen et al [ 63 ] employed Agatston score categories of 0, 1–399, and 400 and larger. Intra- and interrater variability of the categorized Agatston score is, naturally, small due to the limited number of categories [ 64 ], in opposition to analogous investigations of the continuous Agatston score ( Figure 3 ) [ 8 , 40 , 58 ].…”

Section: Discussionmentioning

confidence: 99%

Assessing Agreement When Agreement Is Hard to Assess—The Agatston Score for Coronary Calcification

Andersen

Gerke

2022

Diagnostics

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Method comparison studies comprised simple scatterplots of paired measurements, a 45-degree line as benchmark, and correlation coefficients up to the advent of Bland–Altman analysis in the 1980s. The Agatston score for coronary calcification is based on computed tomography of the heart, and it originated in 1990. A peculiarity of the Agatston score is the often-observed skewed distribution in screening populations. As the Agatston score has manifested itself in preventive cardiology, it is of interest to investigate how reproducibility of the Agatston score has been established. This review is based on literature findings indexed in MEDLINE/PubMed before 20 November 2021. Out of 503 identified articles, 49 papers were included in this review. Sample sizes were highly variable (10–9761), the main focus comprised intra- and interrater as well as intra- and interscanner variability assessments. Simple analysis tools such as scatterplots and correlation coefficients were successively supplemented by first difference, later Bland–Altman plots; however, only very few publications were capable of deriving Limits of Agreement that fit the observed data visually in a convincing way. Moreover, several attempts have been made in the recent past to improve the analysis and reporting of method comparison studies. These warrant increased attention in the future.

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“…Stenosis severity was classified into the following groups: 0%, 1%−24%, 25%−49%, 50%−69%, 70%−99%, and 100%. CCTA results were defined as positive if at least one epicardial coronary artery with a stenotic degree ≥50% and diameter ≥2.0 mm 18 …”

Section: Methodsmentioning

confidence: 99%

“…Occluded vessels were assigned a value of 0.5 19 . CT‐FFR results were defined as positive if the CT‐FFR value ≤0.8 18 …”

Section: Methodsmentioning

confidence: 99%

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ECG‐based cardiodynamicsgram can reflect anomalous functional information in coronary artery disease

Wang

Sun

Kim

et al. 2023

Clinical Cardiology

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Background: The cardiodynamicsgram (CDG), a novel noninvasive method, extracts dynamic ST-T segment information from an electrocardiogram (ECG) through deterministic learning. Hypothesis:The CDG can reflect anomalous functional information in coronary artery disease (CAD).Methods: We retrospectively enrolled 456 patients with suspected CAD who underwent coronary computed tomography angiography (CCTA) from January 2020 to 2022, followed immediately by standard 12-lead ECG acquisition. Positivity for CAD were defined as CCTA ≥ 50% or CT-derived fractional flow reserve (CT-FFR) ≤ 0.8. A CDG value <0 was considered negative; otherwise, it was considered positive. We also evaluated the diagnostic performance of the CDG in the ECGdiagnosis-negative subgroup and in patients who had undergone invasive coronary angiography (ICA) after CCTA.Results: Of 362 patients, 168 (46.41%) were positive for CAD, and 178 (49.17%) were men. The median age was 59 (52−66) years. The accuracy of the CDG in the diagnosis of CAD was 79.56%, with a sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) of 75.60%, 82.99%, and 0.836 (95% CI: 0.794−0.878), respectively. Similarly, in the ECG-diagnosis-negative subgroup (n = 223), the accuracy of the CDG was 80.27%, with an AUC of 0.842 (95% CI: 0.790−0.895). Among the 11 patients with CAD confirmed by ICA, 10 were diagnosed positive by the CDG. Furthermore, the CDG values and CT-FFR were correlated (r = −.395; p < .001). Conclusions:The ECG-based CDG has relatively high specificity and accuracy for the diagnosis of CAD and reflects functional cardiac information to some extent. It has

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Diagnostic and Clinical Value of FFRCT in Stable Chest Pain Patients With Extensive Coronary Calcification

Cited by 28 publications

References 37 publications

On-site CT-derived cFFR in patients with suspected coronary artery disease: Feasibility on a 128-row CT scanner in everyday clinical practice

On-site CT-derived cFFR in patients with suspected coronary artery disease: Feasibility on a 128-row CT scanner in everyday clinical practice

Assessing Agreement When Agreement Is Hard to Assess—The Agatston Score for Coronary Calcification

ECG‐based cardiodynamicsgram can reflect anomalous functional information in coronary artery disease

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