Impact of machine-learning CT-derived fractional flow reserve for the diagnosis and management of coronary artery disease in the randomized CRESCENT trials.
Impact of machine-learning CT-derived fractional flow reserve for the diagnosis and management of coronary artery disease in the randomized CRESCENT trials.
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DOI：
10.1007/s00330-020-06778-w
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发表时间：
2020-07
影响因子：
5.9
通讯作者：
Nieman K
中科院分区：
文献类型：
--
作者：
Nous FMA;Budde RPJ;Lubbers MM;Yamasaki Y;Kardys I;Bruning TA;Akkerhuis JM;Kofflard MJM;Kietselaer B;Galema TW;Nieman K
目的：探讨CT原位血流储备(CT-FFR)对冠脉CT血管成像(CCTA)诊断阻塞性冠状动脉疾病(CAD)的有效性的影响。这项观察性队列研究包括在新月会I和II试验中随机接受心脏CT检查的疑似冠心病患者。所有患者均盲目就地进行CT-FFR检查，所有患者均在CCTA上至少有一个≥狭窄50%，且无排除标准。我们从诊断有效性的角度，即确定最终诊断所需的额外检查次数、初始处理策略的重新分类以及有创冠状动脉造影术的效率(即没有≥50%的ICA发生率)，对狭窄程度为50%的CCTA患者在CT检查中加入CT-FFR的效果进行了评估。53例患者中有53例(14%)至少有1个≥狭窄，其中42/53例(79%)没有排除标准。53例患者中，27例(51%)有明显的血流动力学狭窄(≤为0.80)。与CCTA相比，CT-FFR的可用性将使需要额外检查的患者数量减少57%-点(37/53比7/53，p<；0.001)。最初的治疗策略将改变30名患者(57%，P<；0.001)。将颈内动脉保留给CT-FFR≤为0.80的患者，将减少颈内动脉的数目13%-点(p=0.016)。在CCTA上实施现场CT-FFR可以改变管理，提高梗阻性CAD患者的诊断效率和效果。
To determine the potential impact of on-site CT-derived fractional flow reserve (CT-FFR) on the diagnostic efficiency and effectiveness of coronary CT angiography (CCTA) in patients with obstructive coronary artery disease (CAD) on CCTA. This observational cohort study included patients with suspected CAD who had been randomized to cardiac CT in the CRESCENT I and II trials. On-site CT-FFR was blindly performed in all patients with at least one ≥ 50% stenosis on CCTA and no exclusion criteria for CT-FFR. We retrospectively assessed the effect of adding CT-FFR to the CT protocol in patients with a stenosis ≥ 50% on CCTA in terms of diagnostic effectiveness, i.e., the number of additional tests required to determine the final diagnosis, reclassification of the initial management strategy, and invasive coronary angiography (ICA) efficiency, i.e., ICA rate without ≥ 50% CAD. Fifty-three patients out of the 372 patients (14%) had at least one ≥ 50% stenosis on CCTA of whom 42/53 patients (79%) had no exclusion criteria for CT-FFR. CT-FFR showed a hemodynamically significant stenosis (≤ 0.80) in 27/53 patients (51%). The availability of CT-FFR would have reduced the number of patients requiring additional testing by 57%-points compared with CCTA alone (37/53 vs. 7/53, p < 0.001). The initial management strategy would have changed for 30 patients (57%, p < 0.001). Reserving ICA for patients with a CT-FFR ≤ 0.80 would have reduced the number of ICA following CCTA by 13%-points (p = 0.016). Implementation of on-site CT-FFR may change management and improve diagnostic efficiency and effectiveness in patients with obstructive CAD on CCTA.
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影响因子：
6.2
作者：
Neumann, Franz-Josef;Sousa-Uva, Miguel;Zembala, Michael O.
通讯作者：
Zembala, Michael O.
影响因子：
24
作者：
Hlatky, Mark A.;De Bruyne, Bernard;Douglas, Pamela S.
通讯作者：
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影响因子：
5.4
作者：
Coenen, Adriaan;Lubbers, Marisa M.;Nieman, Koen
通讯作者：
Nieman, Koen
影响因子：
24
作者：
Norgaard, Bjarne L.;Leipsic, Jonathon;Achenbach, Stephan
通讯作者：
Achenbach, Stephan
影响因子：
168.9
作者：
Newby, David;Williams, Michelle;Steedman, Tracey
通讯作者：
Steedman, Tracey