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Song YB, Arbab-Zadeh A, Matheson MB, Ostovaneh MR, Vavere AL, Dewey M, Rochitte C, Niinuma H, Laham R, Schuijf JD, Cox C, Brinker J, di Carli M, Lima JA, Miller JM. Contemporary Discrepancies of Stenosis Assessment by Computed Tomography and Invasive Coronary Angiography. Circ Cardiovasc Imaging 2019; 12:e007720. [DOI: 10.1161/circimaging.118.007720] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.B.S.)
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
| | - Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
| | - Matthew B. Matheson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.B.M., C.C.)
| | - Mohammad R. Ostovaneh
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
| | - Andrea L. Vavere
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
| | - Marc Dewey
- Department of Radiology, Charité Medical School, Humboldt, Berlin, Germany (M.D.)
| | - Carlos Rochitte
- Department of Medicine, InCor Heart Institute, University of Sao Paulo Medical School, Brazil (C.R.)
| | - Hiroyuki Niinuma
- Department of Medicine, Division of Cardiology, Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N.)
| | - Roger Laham
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (R.L.)
| | | | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.B.M., C.C.)
| | - Jeffrey Brinker
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
| | - Marcelo di Carli
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.d.C.)
| | - João A.C. Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
| | - Julie M. Miller
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.B.S., A.A.-Z., M.R.O., A.L.V., J.B., J.A.C.L., J.M.M.)
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Rossi A, Papadopoulou SL, Pugliese F, Russo B, Dharampal AS, Dedic A, Kitslaar PH, Broersen A, Meijboom WB, van Geuns RJ, Wragg A, Ligthart J, Schultz C, Petersen SE, Nieman K, Krestin GP, de Feyter PJ. Quantitative Computed Tomographic Coronary Angiography. Circ Cardiovasc Imaging 2014; 7:43-51. [DOI: 10.1161/circimaging.112.000277] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Coronary lesions with a diameter narrowing ≥50% on visual computed tomographic coronary angiography (CTCA) are generally considered for referral to invasive coronary angiography. However, similar to invasive coronary angiography, visual CTCA is often inaccurate in detecting functionally significant coronary lesions. We sought to compare the diagnostic performance of quantitative CTCA with visual CTCA for the detection of functionally significant coronary lesions using fractional flow reserve (FFR) as the reference standard.
Methods and Results—
CTCA and FFR measurements were obtained in 99 symptomatic patients. In total, 144 coronary lesions detected on CTCA were visually graded for stenosis severity. Quantitative CTCA measurements included lesion length, minimal area diameter, % area stenosis, minimal lumen diameter, % diameter stenosis, and plaque burden [(vessel area−lumen area)/vessel area×100]. Optimal cutoff values of CTCA-derived parameters were determined, and their diagnostic accuracy for the detection of flow-limiting coronary lesions (FFR ≤0.80) was compared with visual CTCA. FFR was ≤0.80 in 54 of 144 (38%) coronary lesions. Optimal cutoff values to predict flow-limiting coronary lesion were 10 mm for lesion length, 1.8 mm
2
for minimal area diameter, 73% for % area stenosis, 1.5 mm for minimal lumen diameter, 48% for % diameter stenosis, and 76% for plaque burden. No significant difference in sensitivity was found between visual CTCA and quantitative CTCA parameters (
P
>0.05). The specificity of visual CTCA (42%; 95% confidence interval [CI], 31%–54%) was lower than that of minimal area diameter (68%; 95% CI, 57%–77%;
P
=0.001), % area stenosis (76%; 95% CI, 65%–84%;
P
<0.001), minimal lumen diameter (67%; 95% CI, 55%–76%;
P
=0.001), % diameter stenosis (72%; 95% CI, 62%–80%;
P
<0.001), and plaque burden (63%; 95% CI, 52%–73%;
P
=0.004). The specificity of lesion length was comparable with that of visual CTCA.
Conclusions—
Quantitative CTCA improves the prediction of functionally significant coronary lesions compared with visual CTCA assessment but remains insufficient. Functional assessment is still required in lesions of moderate stenosis to accurately detect impaired FFR.
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Affiliation(s)
- Alexia Rossi
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Stella-Lida Papadopoulou
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Francesca Pugliese
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Brunella Russo
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Anoeshka S. Dharampal
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Admir Dedic
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Pieter H. Kitslaar
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Alexander Broersen
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - W. Bob Meijboom
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Robert-Jan van Geuns
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Andrew Wragg
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Jurgen Ligthart
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Carl Schultz
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Steffen E. Petersen
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Koen Nieman
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Gabriel P. Krestin
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
| | - Pim J. de Feyter
- From the Department of Radiology (A.R., S.-L.P., B.R., A.S.D., A.D., R.-J.v.G., K.N., P.J.d.F.) and Department of Cardiology (A.R., S.-L.P., A.S.D., A.D., W.B.M., R.-J.v.G., J.L., C.S., K.N., G.P.K., P.J.d.F.), Erasmus University Medical Center, Rotterdam, The Netherlands; Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and The London School of Medicine & Barts Health NHS Trust, London, United Kingdom (F.P., A.W., S.E.P.); and Division of
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