Comprehensive Assessment of Coronary Artery StenosesComputed 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.
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Figure 1 Scatter Plots of FFR Versus QCA, QCT, CCA, and CTCA
Quantitative coronary angiography (QCA), quantitative computed tomography coronary angiography (QCT), CCA, and CTCA are plotted versus FFR. There was a weak, but significant, negative correlation between QCA and FFR (r = –0.30) and between QCT and FFR (r = –0.32). Coronary arteries smaller than 3.5 mm are depicted as solid circles, coronary arteries larger than 3.5 mm as open circles. Abbreviations as in Figure 1.
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Figure 2 CTCA and CCA With FFR Measurement of Intermediate Coronary Lesion
Patient showing a coronary artery stenosis (arrow) in the left anterior descending coronary artery, as visualized with computed tomography coronary angiography (CTCA) (A, volume-rendered image; B and C, 2 orthogonal curved multiplanar reconstructions) and conventional coronary angiography (CCA) (D). By visual assessment, the coronary lesion was estimated as less than 50% diameter stenosis, both by CTCA and CCA. By quantitative analysis, the diameter stenosis was measured as 44% by quantitative coronary angiography and 40% by quantitative CTCA. The fractional flow reserve (FFR) was 0.71 (E). Based on the functional assessment, the patient underwent a successful percutaneous coronary intervention for this anatomically intermediate stenosis.
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Figure 3 CTCA and CCA With FFR Measurement of Intermediate Coronary Lesion
Patient with a coronary artery stenosis (arrow) in the proximal part of the right coronary artery, as visualized with CTCA (A, volume-rendered image; B and C, 2 orthogonal curved multiplanar reconstructions) and CCA (D). Visually, the diameter stenosis was estimated as more than 50%, both by CTCA and CCA. Also, after quantification (56% diameter stenosis by quantitative coronary angiography, 70% diameter stenosis by quantitative CTCA), the lesion appeared to be anatomically significant. The FFR was 0.78 (E). In the distal segments, a step artefact can be seen (A and C, arrowhead). Abbreviations as in Figure 1.
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Figure 4 Scatter Plot and Bland-Altman Analysis of QCT Versus QCA
In the left panel, QCT is plotted versus QCA. A significant correlation is seen between both anatomical techniques (r = 0.53). In the right panel, Bland-Altman analysis showed a bias of +2% with 95% limit of agreement ranging from –21% to 25%. Abbreviations as in Figure 3.
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