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Functional CT for Diagnosing Coronary Artery Disease
Study Questions:
What is the relative accuracy of coronary computed tomography angiography (CCTA), CT perfusion (CTP), fractional flow reserve CT (FFR-CT), transluminal attenuation gradient (TAG), and combined imaging techniques to identify significant coronary artery disease (CAD) using invasive FFR as a reference standard?
Methods:
This meta-analysis compared the sensitivity, specificity, and receiver-operating characteristic curves between tests and test combinations to invasive FFR as a reference standard (with a value ≤0.80 consistent with hemodynamically significant CAD).
Results:
Data from 54 articles including 5,330 patients were examined. At a per-vessel level, pooled sensitivity and specificity were 87% and 61% for CCTA, 81% and 86% for CTP, 82% and 88% for CCTA with CTP, 85% and 78% for FFR-CT, 76% and 80% for CCTA with FFR-CT, 59% and 77% for TAG, and 70% and 92% for CCTA with TAG. The per-vessel receiver-operating characteristic curves demonstrated that CTP, FFR-CT, and CCTA with CTP were superior to CCTA alone.
Conclusions:
FFR-CT and CTP improve the identification of hemodynamically significant CAD over CCTA alone.
Perspective:
It is well demonstrated that invasive FFR improves our ability to identify hemodynamically significant coronary artery lesions over invasive angiography alone, and that revascularization based on invasive FFR improves patient outcomes. This meta-analysis finds that functional testing with CTP or FFR-CT similarly improves our ability to identify hemodynamically significant CAD over CCTA alone. However, it remains to be seen whether the incorporation of CTP or FFR-CT findings to guide revascularization strategy improves clinical outcomes. These findings should prompt further studies to compare clinical outcomes using FFR-CT and CTP in comparison to existing strategies such as vasodilator perfusion imaging or invasive FFR.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging
Keywords: Coronary Angiography, Coronary Artery Disease, Diagnostic Imaging, Fractional Flow Reserve, Myocardial, Hemodynamics, Myocardial Ischemia, Myocardial Revascularization, Perfusion Imaging, ROC Curve, Tomography, X-Ray Computed, Vasodilator Agents
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