Syddansk Universitet PRrospEctive Comparison of FFR Derived From Coronary CT Angiography With SPECT PerfuSion Imaging in Stable Coronary ArtEry DiSeaSe

ISS Fro Un D Ho De D pa OBJECTIVES This study sought to compare the per-patient diagnostic performance of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT) with that of single-photon emission computed tomography (SPECT), using a fractional flow reserve (FFR) value of #0.80 as the reference for diagnosing at least 1 hemodynamically significant stenosis in a head-to-head comparison of patients with intermediate coronary stenosis as determined by coronary CTA. BACKGROUND No previous study has prospectively compared the diagnostic performance of FFRCT and myocardial perfusion imaging by SPECT in symptomatic patients with intermediate range coronary artery disease (CAD). METHODS This study was conducted at a single-center as a prospective study in patients with stable angina pectoris (N 1⁄4 143). FFRCT and SPECT analyses were performed by core laboratories and were blinded for the personnel responsible for downstream patient management. FFRCT #0.80 distally in at least 1 coronary artery with a diameter$2 mm classified patients as having ischemia. Ischemia by SPECT was encountered if a reversible perfusion defect (summed difference score $2) or transitory ischemic dilation of the left ventricle (ratio >1.19) were found. RESULTS The per-patient diagnostic performance for identifying ischemia (95% confidence interval [CI]), FFRCT versus SPECT, were sensitivity of 91% (95% CI: 81% to 97%) versus 41% (95% CI: 29% to 55%; p < 0.001); specificity of 55% (95% CI: 44% to 66%) versus 86% (95% CI: 77% to 93%; p < 0.001); negative predictive value of 90% (95% CI: 82% to 98%) versus 68% (95% CI: 59% to 77%; p 1⁄4 0.001); positive predictive value of 58% (95% CI: 48% to 68%) versus 67% (95% CI: 51% to 82%; p 1⁄4 NS); and accuracy of 70% (95% CI: 62% to 77%) versus 68% (95% CI: 60% to 75%; p 1⁄4 NS) respectively. CONCLUSIONS In patients with stable chest pain and CAD as determined by coronary CTA, the overall diagnostic accuracy levels of FFRCT and SPECT were identical in assessing hemodynamically significant stenosis. However, FFRCT demonstrated a significantly higher diagnostic sensitivity than SPECT. (J Am Coll Cardiol Img 2018;11:1640–50) © 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). N 1936-878X https://doi.org/10.1016/j.jcmg.2018.05.004 m the Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark; Institute of Regional Health Research, iversity of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark; epartment of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aarhus University spital, Skejby, Aarhus, Denmark; Department of Epidemiology, Biostatistics and Bioinformatics, University of Southern nmark, Odense, Denmark; Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; and the epartment of Radiology and Nuclear Medicine, Hospital of Southwest Denmark, Esbjerg, Denmark. Supported by rticipating departments. No external funding was used. Dr. Nørgaard has received institutional research grants from Siemens, ABBR EV I A T I ON S