TY - JOUR
T1 - Comparison Between the Performance of Quantitative Flow Ratio and Perfusion Imaging for Diagnosing Myocardial Ischemia
AU - van Diemen, Pepijn A
AU - Driessen, Roel S
AU - Kooistra, Rolf A
AU - Stuijfzand, Wynand J
AU - Raijmakers, Pieter G
AU - Boellaard, Ronald
AU - Schumacher, Stefan P
AU - Bom, Michiel J
AU - Everaars, Henk
AU - de Winter, Ruben W
AU - van de Ven, Peter M
AU - Reiber, Johan H
AU - Min, James K
AU - Leipsic, Jonathan A
AU - Knuuti, Juhani
AU - Underwood, Richard S
AU - van Rossum, Albert C
AU - Danad, Ibrahim
AU - Knaapen, Paul
N1 - Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2020/9
Y1 - 2020/9
N2 - Objectives: This study compared the performance of the quantitative flow ratio (QFR) with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) myocardial perfusion imaging (MPI) for the diagnosis of fractional flow reserve (FFR)−defined coronary artery disease (CAD). Background: QFR estimates FFR solely based on cine contrast images acquired during invasive coronary angiography (ICA). Head-to-head studies comparing QFR with noninvasive MPI are lacking. Methods: A total of 208 (624 vessels) patients underwent technetium-
99m tetrofosmin SPECT and [
15O]H
2O PET imaging before ICA in conjunction with FFR measurements. ICA was obtained without using a dedicated QFR acquisition protocol, and QFR computation was attempted in all vessels interrogated by FFR (552 vessels). Results: QFR computation succeeded in 286 (52%) vessels. QFR correlated well with invasive FFR overall (R = 0.79; p < 0.001) and in the subset of vessels with an intermediate (30% to 90%) diameter stenosis (R = 0.76; p < 0.001). Overall, per-vessel analysis demonstrated QFR to exhibit a superior sensitivity (70%) in comparison with SPECT (29%; p < 0.001), whereas it was similar to PET (75%; p = 1.000). Specificity of QFR (93%) was higher than PET (79%; p < 0.001) and not different from SPECT (96%; p = 1.000). As such, the accuracy of QFR (88%) was superior to both SPECT (82%; p = 0.010) and PET (78%; p = 0.004). Lastly, the area under the receiver operating characteristics curve of QFR, in the overall sample (0.94) and among vessels with an intermediate lesion (0.90) was higher than SPECT (0.63 and 0.61; p < 0.001 for both) and PET (0.82; p < 0.001 and 0.77; p = 0.002), respectively. Conclusions: In this head-to-head comparative study, QFR exhibited a higher diagnostic value for detecting FFR-defined significant CAD compared with perfusion imaging by SPECT or PET.
AB - Objectives: This study compared the performance of the quantitative flow ratio (QFR) with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) myocardial perfusion imaging (MPI) for the diagnosis of fractional flow reserve (FFR)−defined coronary artery disease (CAD). Background: QFR estimates FFR solely based on cine contrast images acquired during invasive coronary angiography (ICA). Head-to-head studies comparing QFR with noninvasive MPI are lacking. Methods: A total of 208 (624 vessels) patients underwent technetium-
99m tetrofosmin SPECT and [
15O]H
2O PET imaging before ICA in conjunction with FFR measurements. ICA was obtained without using a dedicated QFR acquisition protocol, and QFR computation was attempted in all vessels interrogated by FFR (552 vessels). Results: QFR computation succeeded in 286 (52%) vessels. QFR correlated well with invasive FFR overall (R = 0.79; p < 0.001) and in the subset of vessels with an intermediate (30% to 90%) diameter stenosis (R = 0.76; p < 0.001). Overall, per-vessel analysis demonstrated QFR to exhibit a superior sensitivity (70%) in comparison with SPECT (29%; p < 0.001), whereas it was similar to PET (75%; p = 1.000). Specificity of QFR (93%) was higher than PET (79%; p < 0.001) and not different from SPECT (96%; p = 1.000). As such, the accuracy of QFR (88%) was superior to both SPECT (82%; p = 0.010) and PET (78%; p = 0.004). Lastly, the area under the receiver operating characteristics curve of QFR, in the overall sample (0.94) and among vessels with an intermediate lesion (0.90) was higher than SPECT (0.63 and 0.61; p < 0.001 for both) and PET (0.82; p < 0.001 and 0.77; p = 0.002), respectively. Conclusions: In this head-to-head comparative study, QFR exhibited a higher diagnostic value for detecting FFR-defined significant CAD compared with perfusion imaging by SPECT or PET.
KW - fractional flow reserve
KW - positron emission tomography
KW - quantitative flow ratio
KW - single-photon emission computed tomography
UR - http://www.scopus.com/inward/record.url?scp=85089307941&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2020.02.012
DO - 10.1016/j.jcmg.2020.02.012
M3 - Article
C2 - 32305469
VL - 13
SP - 1976
EP - 1985
JO - JACC. Cardiovascular imaging
JF - JACC. Cardiovascular imaging
SN - 1876-7591
IS - 9
ER -