Functional CAD-RADS using FFR CT on therapeutic management and prognosis in patients with coronary artery disease.

Autor: Tang CX; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China., Qiao HY; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China., Zhang XL; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China., Di Jiang M; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China., Schoepf UJ; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA., Rudziński PN; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.; Department of Coronary and Structural Heart Diseases, The Cardinal Stefan Wyszyński Institute of Cardiology, Warsaw, 200233, Poland., Giovagnoli DP; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA., Lu MJ; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China., Li JH; Department of Cardiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China., Wang YN; Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China., Zhang JY; Institute of Diagnostic and Interventional Radiology, and Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yi Shan Rd, Shanghai, 200233, China., Hou Y; Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110001, China., Zheng MW; Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China., Zhang B; Department of Radiology, Jiangsu Taizhou People's Hospital, Taizhou, 225300, China., Zhang DM; Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China., Hu XH; Department of Radiology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Zhejiang, 310006, Hangzhou, China., Xu L; Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 10029, China., Liu H; Department of Radiology, Guangdong Provincial People's Hospital, Guangzhou, 510000, China., Lu GM; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China. cjr.luguangming@vip.163.com., Zhang LJ; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China. kevinzhlj@163.com.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2022 Aug; Vol. 32 (8), pp. 5210-5221. Date of Electronic Publication: 2022 Mar 08.
DOI: 10.1007/s00330-022-08618-5
Abstrakt: Objectives: To propose a novel functional Coronary Artery Disease-Reporting and Data System (CAD-RADS) category system integrated with coronary CT angiography (CCTA)-derived fractional flow reserve (FFR CT ) and to validate its effect on therapeutic decision and prognosis in patients with coronary artery disease (CAD).
Methods: Firstly, we proposed a novel functional CAD-RADS and evaluated the performance of functional CAD-RADS for guiding treatment strategies with actual clinical treatment as a reference standard in a retrospective multicenter cohort with CCTA and invasive FFR performed in all patients (n = 466). Net reclassification improvement (NRI) of functional CAD-RADS over anatomical CAD-RADS was calculated. Secondly, the prognostic value of functional CAD-RADS in a prospective two-arm cohort (566 [FFR CT arm] vs. 567 [CCTA arm]) was calculated, after a 1-year follow-up, functional CAD-RADS in FFR CT arm (n = 513) and anatomical CAD-RADS in CCTA arm (n = 511) to determine patients at risk of adverse outcomes were compared with a Cox hazard proportional model.
Results: Functional CAD-RADS demonstrated superior value over anatomical CAD-RADS (AUC: 0.828 vs. 0.681, p < 0.001) and comparable performance to FFR (AUC: 0.828 vs. 0.848, p = 0.253) in guiding therapeutic decisions. Functional CAD-RADS resulted in the revision of management plan as determined by anatomical CAD-RADS in 30.0% of patients (n = 140) (NRI = 0.369, p < 0.001). Functional CAD-RADS was an independent predictor for 1-year outcomes with indexes of concordance of 0.795 and the corresponding value was 0.751 in anatomical CAD-RADS.
Conclusion: The novel functional CAD-RADS gained incremental value in guiding therapeutic decision-making compared with anatomical CAD-RADS and comparable power in 1-year prognosis with anatomical CAD-RADS in a real-world scenario.
Key Points: • The novel functional CAD-RADS category system with FFR CT integrated into the anatomical CAD-RADS categories was originally proposed. • The novel functional CAD-RADS category system was validated superior value over anatomical CAD-RADS (AUC: 0.828 vs. 0.681, p < 0.001) in guiding therapeutic decisions and revised management plan in 30.0% of patients as determined by anatomical CAD-RADS (net reclassification improvement index = 0.369, p < 0.001). • Functional CAD-RADS was an independent predictor with an index of concordance of 0.795 and 0.751 in anatomical CAD-RADS for 1-year prognosis of adverse outcomes.
(© 2022. The Author(s), under exclusive licence to European Society of Radiology.)
Databáze: MEDLINE
Externí odkaz: