Anatomical and Functional Computed Tomography for Diagnosing Hemodynamically Significant Coronary Artery Disease

A Meta-Analysis

Csilla Celeng, Tim Leiner, Pál Maurovich-Horvat, B. Merkely, Pim de Jong, Jan W. Dankbaar, Hendrik W. van Es, Brian B. Ghoshhajra, Udo Hoffmann, Richard A.P. Takx

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives: This meta-analysis determined the diagnostic performance of coronary computed tomography (CT) angiography (CTA), CT myocardial perfusion (CTP), fractional flow reserve CT (FFRCT), the transluminal attenuation gradient (TAG), and their combined use with CTA versus FFR as a reference standard for detection of hemodynamically significant coronary artery disease (CAD). Background: CTA provides excellent anatomic, albeit limited functional information for the evaluation of CAD. Recently, various functional CT techniques emerged to assess the hemodynamic consequences of CAD. Methods: This meta-analysis was performed in adherence to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE, and Web of Science were searched from inception until September 7, 2017. Bayesian random effects analysis was used to compute pooled sensitivity, specificity, and the summary receiver-operating characteristic curve of the index tests and compare them with the FFR as a reference standard. Analyses were performed on vessel and patient levels. Because CTA has excellent sensitivity, specificity was considered most relevant. Individual FFRCT values were collected. Results: Overall, 54 articles and 5,330 patients were included. At vessel level, pooled specificity of CTP (0.86; 95% confidence interval [CI]: 0.76 to 0.93), FFRCT (0.78; 95% CI: 0.72 to 0.83) and TAG (0.77; 95% CI: 0.61 to 0.89) were substantially higher than that of CTA (0.61; 95% CI: 0.54 to 0.68). The addition of FFRCT, CTP, and TAG to CTA resulted in high to excellent specificities (0.80 to 0.92). The summary receiver-operating characteristic curve at vessel level yielded superior diagnostic accuracy for CTP, FFRCT, and combined CTA and CTP, compared with CTA. A subanalysis of on-site versus off-site FFRCT revealed no substantial differences between the sensitivity (0.84 vs. 0.85) and specificity (0.80 vs. 0.73) of the 2 techniques. In a second subanalysis, dynamic CTP showed higher sensitivity (0.85 vs. 0.72), but had a lower specificity (0.81 vs. 0.90) than static CTP. Conclusions: CTP and FFRCT demonstrated a substantial improvement in the identification of hemodynamically significant CAD compared with CTA; therefore, their integration to clinical workflow before revascularization is recommended.

Original languageEnglish
Pages (from-to)1316-1325
Number of pages10
JournalJACC: Cardiovascular Imaging
Volume12
Issue number7
DOIs
Publication statusPublished - Jul 1 2019

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Meta-Analysis
Coronary Artery Disease
Tomography
Perfusion
Myocardial Fractional Flow Reserve
Confidence Intervals
ROC Curve
Computed Tomography Angiography
Sensitivity and Specificity
Workflow
PubMed
Hemodynamics
Guidelines

Keywords

  • computed tomography
  • coronary artery disease
  • fractional flow reserve
  • meta-analysis
  • myocardial perfusion imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Anatomical and Functional Computed Tomography for Diagnosing Hemodynamically Significant Coronary Artery Disease : A Meta-Analysis. / Celeng, Csilla; Leiner, Tim; Maurovich-Horvat, Pál; Merkely, B.; de Jong, Pim; Dankbaar, Jan W.; van Es, Hendrik W.; Ghoshhajra, Brian B.; Hoffmann, Udo; Takx, Richard A.P.

In: JACC: Cardiovascular Imaging, Vol. 12, No. 7, 01.07.2019, p. 1316-1325.

Research output: Contribution to journalArticle

Celeng, C, Leiner, T, Maurovich-Horvat, P, Merkely, B, de Jong, P, Dankbaar, JW, van Es, HW, Ghoshhajra, BB, Hoffmann, U & Takx, RAP 2019, 'Anatomical and Functional Computed Tomography for Diagnosing Hemodynamically Significant Coronary Artery Disease: A Meta-Analysis', JACC: Cardiovascular Imaging, vol. 12, no. 7, pp. 1316-1325. https://doi.org/10.1016/j.jcmg.2018.07.022
Celeng, Csilla ; Leiner, Tim ; Maurovich-Horvat, Pál ; Merkely, B. ; de Jong, Pim ; Dankbaar, Jan W. ; van Es, Hendrik W. ; Ghoshhajra, Brian B. ; Hoffmann, Udo ; Takx, Richard A.P. / Anatomical and Functional Computed Tomography for Diagnosing Hemodynamically Significant Coronary Artery Disease : A Meta-Analysis. In: JACC: Cardiovascular Imaging. 2019 ; Vol. 12, No. 7. pp. 1316-1325.
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T2 - A Meta-Analysis

AU - Celeng, Csilla

AU - Leiner, Tim

AU - Maurovich-Horvat, Pál

AU - Merkely, B.

AU - de Jong, Pim

AU - Dankbaar, Jan W.

AU - van Es, Hendrik W.

AU - Ghoshhajra, Brian B.

AU - Hoffmann, Udo

AU - Takx, Richard A.P.

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N2 - Objectives: This meta-analysis determined the diagnostic performance of coronary computed tomography (CT) angiography (CTA), CT myocardial perfusion (CTP), fractional flow reserve CT (FFRCT), the transluminal attenuation gradient (TAG), and their combined use with CTA versus FFR as a reference standard for detection of hemodynamically significant coronary artery disease (CAD). Background: CTA provides excellent anatomic, albeit limited functional information for the evaluation of CAD. Recently, various functional CT techniques emerged to assess the hemodynamic consequences of CAD. Methods: This meta-analysis was performed in adherence to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE, and Web of Science were searched from inception until September 7, 2017. Bayesian random effects analysis was used to compute pooled sensitivity, specificity, and the summary receiver-operating characteristic curve of the index tests and compare them with the FFR as a reference standard. Analyses were performed on vessel and patient levels. Because CTA has excellent sensitivity, specificity was considered most relevant. Individual FFRCT values were collected. Results: Overall, 54 articles and 5,330 patients were included. At vessel level, pooled specificity of CTP (0.86; 95% confidence interval [CI]: 0.76 to 0.93), FFRCT (0.78; 95% CI: 0.72 to 0.83) and TAG (0.77; 95% CI: 0.61 to 0.89) were substantially higher than that of CTA (0.61; 95% CI: 0.54 to 0.68). The addition of FFRCT, CTP, and TAG to CTA resulted in high to excellent specificities (0.80 to 0.92). The summary receiver-operating characteristic curve at vessel level yielded superior diagnostic accuracy for CTP, FFRCT, and combined CTA and CTP, compared with CTA. A subanalysis of on-site versus off-site FFRCT revealed no substantial differences between the sensitivity (0.84 vs. 0.85) and specificity (0.80 vs. 0.73) of the 2 techniques. In a second subanalysis, dynamic CTP showed higher sensitivity (0.85 vs. 0.72), but had a lower specificity (0.81 vs. 0.90) than static CTP. Conclusions: CTP and FFRCT demonstrated a substantial improvement in the identification of hemodynamically significant CAD compared with CTA; therefore, their integration to clinical workflow before revascularization is recommended.

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KW - fractional flow reserve

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