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CLINICAL RESEARCH: CARDIAC IMAGING

Comprehensive Assessment of Coronary Artery Stenoses

Computed Tomography Coronary Angiography Versus Conventional Coronary Angiography and Correlation With Fractional Flow Reserve in Patients With Stable Angina

W. Bob Meijboom, MD^_*,, Carlos A.G. Van Mieghem, MD^_*,, Niels van Pelt, MD^_*,, Annick Weustink, MD^_*,, Francesca Pugliese, MD^_*,, Nico R. Mollet, MD, PhD^_*,, Eric Boersma, PhD^_*, Eveline Regar, MD, PhD^_*, Robert J. van Geuns, MD, PhD^_*,, Peter J. de Jaegere, MD, PhD^_*, Patrick W. Serruys, MD, PhD, FACC^_*, Gabriel P. Krestin, MD, PhD and Pim J. de Feyter, MD, PhD, FACC^_*,,_*

^_* Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.

Manuscript received October 18, 2007; revised manuscript received April 28, 2008, accepted May 6, 2008.

^_* Reprint requests and correspondence: Dr. Pim J. de Feyter, Erasmus MC, Department of Cardiology and Radiology, Room Hs 227, ‘s Gravendijkwal 230, P.O. Box 2040, 3015 GD, Rotterdam, the Netherlands. (Email: p.j.defeyter{at}erasmusmc.nl).

Objectives: We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography coronary angiography [CTCA]) and quantitative computed tomography coronary angiography (QCT) to predict the hemodynamic significance of a coronary stenosis, using intracoronary fractional flow reserve (FFR) as the reference standard.

Background: It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying coronary stenoses, but may lack accurate delineation of the hemodynamic significance.

Methods: We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete coronary stenoses. CTCA and conventional coronary angiography (CCA), and QCT and quantitative coronary angiography (QCA), were performed to determine the severity of a stenosis that was compared with FFR measurements. A significant anatomical or functional stenosis was defined as 50% diameter stenosis or an FFR <0.75. Stented segments and bypass grafts were not included in the analysis.

Results: A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR <0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of –0.32 and –0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R = 0.53; p < 0.0001).

Conclusions: The anatomical assessment of the hemodynamic significance of coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate stenosis remains relevant before referral for revascularization treatment.

Key Words: coronary artery disease • computed tomography • coronary angiography • fractional flow reserve • quantification

Abbreviations and Acronyms   CAD = coronary artery disease   CCA = conventional coronary angiogram   CT = computed tomography   CTCA = computed tomography coronary angiogram   FFR = fractional flow reserve   QCA = quantitative coronary angiography   QCT = quantitative computed tomography coronary angiography

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