Diagnostic Performance of a Novel Cadmium-Zinc-Telluride Gamma Camera System Assessed Using Fractional Flow Reserve

Abstract Introduction Coronary CT angiography (CTA) derived fractional flow reserve (FFRct) is increasingly used for guiding referral to invasive procedures in patients with stable chest pain. However, optimal interpretation of FFRct-analysis in terms of location and threshold of applied FFRct-values is unclear. Purpose To evaluate the clinical performance of various vessel-specific physiological FFRct derived measures of ischemia for prediction of standard of care guided coronary revascularization in patients with stable chest pain and coronary artery disease as determined by coronary CTA. Methods Retrospective study in patients with stable chest pain referred for coronary angiography based on coronary CTA. Standard acquired coronary CTA data sets were transmitted for core-laboratory analysis at HeartFlow. Any FFRct value in the major coronary arteries ≥1.8 mm in diameter, including side branches, were registered. Lesions were categorized as positive for ischemia using 6 different algorithms: Lowest in vessel FFRct-value (1) ≤0.75 or (2) ≤0.80; 2 cm distal-to-lesion FFRct-value (3) ≤0.75 or (4) ≤0.80; ΔFFRct (5) ≥0.06 or a combination of 2 and 5. The personnel responsible for downstream patient management had no information regarding FFRct test results. Results A total of 172 patients were included. Revascularization was performed in 62 (35%) patients. The diagnostic performance of different FFRct algorithms for predicting standard of care guided coronary revascularization is shown in the Table. Revascularization Predictions by FFRct N=172 Diagnostic performance FFRCT false negative FFRCT false positive Values given as (%) No. of revasc vessels No. of abnormal vessels FFRCT Algorithm Sens Spec PPV NPV Acc 1 2 3 1 2 3 Distal FFRCT ≤0.75 77 68 58 84 72 12 2 0 29 5 1 Distal FFRCT ≤0.80 92 43 48 90 61 5 0 0 40 20 3 Lesion-specific FFRCT ≤0.75 68 86 74 83 80 17 3 0 12 3 0 Lesion-specific FFRCT ≤0.80 82 78 68 89 80 10 2 0 21 3 1 ΔFFRCT ≥0.06 98 36 47 98 59 1 0 0 51 19 0 Combinationa 92 54 53 92 67 5 0 0 39 12 0 aDistal FFRCT ≤0.80 and ΔFFRCT ≥0.06. Sens = sensitivity; Spec = specificity; PPV = positive predictive value; NPV = negative predictive value; Acc = accuracy; FFRCT = fractional flow reserve derived from coronary CTA; ΔFFRCT = difference between FFRCT-value immediately proximal and distal to lesion; Revasc = revascularized. Conclusion The diagnostic performance of FFRct in terms of predicting standard of care guided coronary revascularization is dependent on the applied algorithm for interpretation of the FFRct-analysis.

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First Experience DaTSCAN Imaging Using Cadmium-Zinc-Telluride Gamma Camera SPECT

Clinical Nuclear Medicine ◽

10.1097/rlu.0b013e3182443f47 ◽

2012 ◽

Vol 37 (8) ◽

pp. e211-e212 ◽

Cited By ~ 1

Author(s):

Karim Farid ◽

Mathieu Queneau ◽

Mohamed Guernou ◽

David Lussato ◽

Xavier Poullias ◽

...

Keyword(s):

Gamma Camera ◽

Cadmium Zinc Telluride ◽

Zinc Telluride ◽

Cadmium Zinc

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Non‐invasive coronary CT angiography‐derived fractional flow reserve: A benchmark study comparing the diagnostic performance of four different computational methodologies

International Journal for Numerical Methods in Biomedical Engineering ◽

10.1002/cnm.3235 ◽

2019 ◽

Vol 35 (10) ◽

Cited By ~ 6

Author(s):

Jason Matthew Carson ◽

Sanjay Pant ◽

Carl Roobottom ◽

Robin Alcock ◽

Pablo Javier Blanco ◽

...

Keyword(s):

Ct Angiography ◽

Fractional Flow Reserve ◽

Diagnostic Performance ◽

Coronary Ct Angiography ◽

Fractional Flow ◽

Non Invasive ◽

Benchmark Study ◽

Coronary Ct ◽

Flow Reserve

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Gender differences in the diagnostic performance of machine learning coronary CT angiography-derived fractional flow reserve -results from the MACHINE registry

European Journal of Radiology ◽

10.1016/j.ejrad.2019.108657 ◽

2019 ◽

Vol 119 ◽

pp. 108657 ◽

Cited By ~ 6

Author(s):

Stefan Baumann ◽

Matthias Renker ◽

U. Joseph Schoepf ◽

Carlo N. De Cecco ◽

Adriaan Coenen ◽

...

Keyword(s):

Machine Learning ◽

Gender Differences ◽

Ct Angiography ◽

Fractional Flow Reserve ◽

Diagnostic Performance ◽

Coronary Ct Angiography ◽

Fractional Flow ◽

Coronary Ct ◽

Flow Reserve

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Meta-Analysis of Diagnostic Performance of Contrast-Fractional Flow Reserve versus Quantitative Flow Ratio for Functional Assessment of Coronary Stenoses

Journal of Interventional Cardiology ◽

10.1155/2020/7352150 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Ruitao Zhang ◽

Jianwei Zhang ◽

Lijun Guo

Keyword(s):

Sensitivity And Specificity ◽

Fractional Flow Reserve ◽

Coronary Stenosis ◽

Diagnostic Performance ◽

Meta Analysis ◽

Flow Ratio ◽

Fractional Flow ◽

Flow Reserve ◽

Quantitative Flow Ratio ◽

Quantitative Flow

Background. Use of the fractional flow reserve (FFR) technique is recommended to evaluate coronary stenosis severity and guide revascularization. However, its high cost, time to administer, and the side effects of adenosine reduce its clinical utility. Two novel adenosine-free indices, contrast-FFR (cFFR) and quantitative flow ratio (QFR), can simplify the functional evaluation of coronary stenosis. This study aimed to analyze the diagnostic performance of cFFR and QFR using FFR as a reference index. Methods. We conducted a systematic review and meta-analysis of observational studies in which cFFR or QFR was compared to FFR. A bivariate model was applied to pool diagnostic parameters. Cochran’s Q test and the I2 index were used to assess heterogeneity and identify the potential source of heterogeneity by metaregression and sensitivity analysis. Results. Overall, 2220 and 3000 coronary lesions from 20 studies were evaluated by cFFR and QFR, respectively. The pooled sensitivity and specificity were 0.87 (95% CI: 0.81, 0.91) and 0.92 (95% CI: 0.88, 0.94) for cFFR and 0.87 (95% CI: 0.82, 0.91) and 0.91 (95% CI: 0.87, 0.93) for QFR, respectively. No statistical significance of sensitivity and specificity for cFFR and QFR were observed in the bivariate analysis (P=0.8406 and 0.4397, resp.). The area under summary receiver-operating curve of cFFR and QFR was 0.95 (95% CI: 0.93, 0.97) for cFFR and 0.95 (95% CI: 0.93, 0.97). Conclusion. Both cFFR and QFR have good diagnostic performance in detecting functional severity of coronary arteries and showed similar diagnostic parameters.

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