Coronary Artery Stenosis Evaluation by Angiography-Derived FFR: Validation by Positron Emission Tomography and Invasive Thermodilution.

Autor:	Westra J; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Linköping University Hospital, Linköping, Sweden. Electronic address: jelmer.westra@clin.au.dk., Rasmussen LD; Department of Cardiology, Gødstrup Hospital, Herning, Denmark., Eftekhari A; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Winther S; Department of Cardiology, Gødstrup Hospital, Herning, Denmark., Karim SR; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Johansen JK; Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark., Hammid O; Department of Cardiology, Regional Hospital East Jutland, Randers, Denmark., Søndergaard HM; Department of Cardiology, Regional Hospital Central Jutland, Viborg, Denmark., Ejlersen JA; Department of Clinical Physiology, Regional Hospital Central Jutland, Viborg, Denmark; Department of Nuclear Medicine, Hospital Unit West, Herning, Denmark., Gormsen LC; Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark., Mogensen LJH; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Bøttcher M; Department of Cardiology, Gødstrup Hospital, Herning, Denmark., Holm NR; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Christiansen EH; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2023 Oct; Vol. 16 (10), pp. 1321-1331. Date of Electronic Publication: 2023 Apr 12.
DOI:	10.1016/j.jcmg.2023.02.008
Abstrakt:	Background: Fractional flow reserve (FFR) derived from invasive coronary angiography (QFR) is promising for evaluation of intermediate coronary artery stenosis. Objectives: The authors aimed to compare the diagnostic performance of QFR and the guideline-recommended invasive FFR using 82 Rubidium positron emission tomography ( 82 Rb-PET) myocardial perfusion imaging as reference standard. Methods: This is a prospective, observational study of symptomatic patients with suspected obstructive coronary artery disease on coronary computed tomography angiography (≥50% diameter stenosis in ≥1 vessel). All patients were referred to 82 Rb-PET and invasive coronary angiography with FFR and QFR assessment of all intermediate (30%-90% diameter stenosis) stenoses. Main analyses included a comparison of the ability of QFR and FFR to identify reduced myocardial blood flow (<2 mL/g/min) during vasodilation and/or relative perfusion abnormalities (summed stress score ≥4 in ≥2 adjacent segments). Results: A total of 250 patients (320 vessels) with indication for invasive physiological assessment were included. The continuous relationship of 82 Rb-PET stress myocardial blood flow per 0.10 increase in FFR was +0.14 mL/g/min (95% CI: 0.07-0.21 mL/g/min) and +0.08 mL/g/min (95% CI: 0.02-0.14 mL/g/min) per 0.10 QFR increase. Using 82 Rb-PET as reference, QFR and FFR had similar diagnostic performance on both a per-patient level (accuracy: 73%; 95% CI: 67%-79%; vs accuracy: 71%; 95% CI: 64%-78%) and per-vessel level (accuracy: 70%; 95% CI: 64%-75%; vs accuracy: 68%; 95% CI: 62%-73%). The per-vessel feasibility was 84% (95% CI: 80%-88%) for QFR and 88% (95% CI: 85%-92%) for FFR by intention-to-diagnose analysis. Conclusions: With 82 Rb-PET as reference modality, the wire-free QFR solution showed similar diagnostic accuracy as invasive FFR in evaluation of intermediate coronary stenosis. (DAN-NICAD - Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease; NCT02264717). Competing Interests: Funding Support and Author Disclosures Dr Winther acknowledges support from the Novo Nordisk Foundation Clinical Emerging Investigator grant (NNF21OC0066981). Dr Bøttcher discloses advisory board participation for NOVO Nordisk, AstraZeneca, Pfizer, Boehringer Ingelheim, Bayer, Sanofi, Novartis, AMGEN, CLS-Behring, and Acarix. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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