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Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study

Although on-site workstation-based CT fractional flow reserve (CT-FFR) is an emerging method for assessing vessel-specific ischemia in coronary artery disease, severe calcification is a significant factor affecting CT-FFR’s diagnostic performance. The subtraction method significantly improves the di...

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Autores principales: Kamo, Yuki, Fujimoto, Shinichiro, Nozaki, Yui O., Aoshima, Chihiro, Kawaguchi, Yuko O., Dohi, Tomotaka, Kudo, Ayako, Takahashi, Daigo, Takamura, Kazuhisa, Hiki, Makoto, Okai, Iwao, Okazaki, Shinya, Tomizawa, Nobuo, Kumamaru, Kanako K., Aoki, Shigeki, Minamino, Tohru
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509262/
https://www.ncbi.nlm.nih.gov/pubmed/34640414
http://dx.doi.org/10.3390/jcm10194398
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author Kamo, Yuki
Fujimoto, Shinichiro
Nozaki, Yui O.
Aoshima, Chihiro
Kawaguchi, Yuko O.
Dohi, Tomotaka
Kudo, Ayako
Takahashi, Daigo
Takamura, Kazuhisa
Hiki, Makoto
Okai, Iwao
Okazaki, Shinya
Tomizawa, Nobuo
Kumamaru, Kanako K.
Aoki, Shigeki
Minamino, Tohru
author_facet Kamo, Yuki
Fujimoto, Shinichiro
Nozaki, Yui O.
Aoshima, Chihiro
Kawaguchi, Yuko O.
Dohi, Tomotaka
Kudo, Ayako
Takahashi, Daigo
Takamura, Kazuhisa
Hiki, Makoto
Okai, Iwao
Okazaki, Shinya
Tomizawa, Nobuo
Kumamaru, Kanako K.
Aoki, Shigeki
Minamino, Tohru
author_sort Kamo, Yuki
collection PubMed
description Although on-site workstation-based CT fractional flow reserve (CT-FFR) is an emerging method for assessing vessel-specific ischemia in coronary artery disease, severe calcification is a significant factor affecting CT-FFR’s diagnostic performance. The subtraction method significantly improves the diagnostic value with respect to anatomic stenosis for patients with severe calcification in coronary CT angiography (CCTA). We evaluated the diagnostic capability of CT-FFR using the subtraction method (subtraction CT-FFR) in patients with severe calcification. This study included 32 patients with 45 lesions with severe calcification (Agatston score >400) who underwent both CCTA and subtraction CCTA using 320-row area detector CT and also received invasive FFR within 90 days. The diagnostic capabilities of CT-FFR and subtraction CT-FFR were compared. The sensitivities, specificities, positive predictive values (PPVs), and negative predictive values (NPVs) of CT-FFR vs. subtraction CT-FFR for detecting hemodynamically significant stenosis, defined as FFR ≤ 0.8, were 84.6% vs. 92.3%, 59.4% vs. 75.0%, 45.8% vs. 60.0%, and 90.5% vs. 96.0%, respectively. The area under the curve for subtraction CT-FFR was significantly higher than for CT-FFR (0.84 vs. 0.70) (p = 0.04). The inter-observer and intra-observer variabilities of subtraction CT-FFR were 0.76 and 0.75, respectively. In patients with severe calcification, subtraction CT-FFR had an incremental diagnostic value over CT-FFR, increasing the specificity and PPV while maintaining the sensitivity and NPV with high reproducibility.
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spelling pubmed-85092622021-10-13 Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study Kamo, Yuki Fujimoto, Shinichiro Nozaki, Yui O. Aoshima, Chihiro Kawaguchi, Yuko O. Dohi, Tomotaka Kudo, Ayako Takahashi, Daigo Takamura, Kazuhisa Hiki, Makoto Okai, Iwao Okazaki, Shinya Tomizawa, Nobuo Kumamaru, Kanako K. Aoki, Shigeki Minamino, Tohru J Clin Med Article Although on-site workstation-based CT fractional flow reserve (CT-FFR) is an emerging method for assessing vessel-specific ischemia in coronary artery disease, severe calcification is a significant factor affecting CT-FFR’s diagnostic performance. The subtraction method significantly improves the diagnostic value with respect to anatomic stenosis for patients with severe calcification in coronary CT angiography (CCTA). We evaluated the diagnostic capability of CT-FFR using the subtraction method (subtraction CT-FFR) in patients with severe calcification. This study included 32 patients with 45 lesions with severe calcification (Agatston score >400) who underwent both CCTA and subtraction CCTA using 320-row area detector CT and also received invasive FFR within 90 days. The diagnostic capabilities of CT-FFR and subtraction CT-FFR were compared. The sensitivities, specificities, positive predictive values (PPVs), and negative predictive values (NPVs) of CT-FFR vs. subtraction CT-FFR for detecting hemodynamically significant stenosis, defined as FFR ≤ 0.8, were 84.6% vs. 92.3%, 59.4% vs. 75.0%, 45.8% vs. 60.0%, and 90.5% vs. 96.0%, respectively. The area under the curve for subtraction CT-FFR was significantly higher than for CT-FFR (0.84 vs. 0.70) (p = 0.04). The inter-observer and intra-observer variabilities of subtraction CT-FFR were 0.76 and 0.75, respectively. In patients with severe calcification, subtraction CT-FFR had an incremental diagnostic value over CT-FFR, increasing the specificity and PPV while maintaining the sensitivity and NPV with high reproducibility. MDPI 2021-09-26 /pmc/articles/PMC8509262/ /pubmed/34640414 http://dx.doi.org/10.3390/jcm10194398 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kamo, Yuki
Fujimoto, Shinichiro
Nozaki, Yui O.
Aoshima, Chihiro
Kawaguchi, Yuko O.
Dohi, Tomotaka
Kudo, Ayako
Takahashi, Daigo
Takamura, Kazuhisa
Hiki, Makoto
Okai, Iwao
Okazaki, Shinya
Tomizawa, Nobuo
Kumamaru, Kanako K.
Aoki, Shigeki
Minamino, Tohru
Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study
title Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study
title_full Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study
title_fullStr Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study
title_full_unstemmed Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study
title_short Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study
title_sort incremental diagnostic value of ct fractional flow reserve using subtraction method in patients with severe calcification: a pilot study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509262/
https://www.ncbi.nlm.nih.gov/pubmed/34640414
http://dx.doi.org/10.3390/jcm10194398
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