Response to letter regarding article, "Noninvasive fractional flow reserve derived from computed tomography angiography for coronary lesions of intermediate stenosis severity: results from the DeFACTO study".
Response to letter regarding article, "Noninvasive fractional flow reserve derived from computed tomography angiography for coronary lesions of intermediate stenosis severity: results from the DeFACTO study".
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对有关文章“针对中度狭窄严重程度的冠状动脉病变的计算机断层扫描血管造影得出的无创血流储备分数：DeFACTO 研究的结果”的回复。
DOI：
10.1161/circimaging.114.001523
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Min,JamesK
中科院分区：
文献类型：
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作者：
Nakazato,Ryo;Park,Hyung-Bok;Berman,DanielS;Gransar,Heidi;Koo,Bon-Kwon;Erglis,Andrejs;Lin,FayY;Dunning,AllisonM;Budoff,MatthewJ;Malpeso,Jennifer;Leipsic,Jonathon;Min,JamesK
我们感谢Mao等人1的周到来信，以及他们对我们前瞻性、多中心研究的兴趣，该研究证明了计算机断层扫描（FFR CT）获得的分数血流储备在识别和排除中度狭窄的病变特异性缺血方面的高诊断性能。2毛博士等人对我们的研究表达了担忧，我们在此予以说明。首先，Mao等人1认为“动脉壁的弹性对体内心脏灌注压的影响很大，在FFR CT的计算中不恰当地忽略了这一点。”虽然后一种说法是正确的，但前一种说法根本不是。FFR CT -类似于FFR本身-是一个时间平均值，因此，动脉壁弹性对FFR CT诊断性能的影响可以忽略不计。其次，对于中度狭窄严重程度的病变，其缺血率不可忽视，但普遍较低，因此对疑似缺血性心脏病患者进行诊断检查的一个主要目标是有效排除有缺血性病变的患者。在本研究中，FFR CT（一种诊断可靠的计算方法，比单独的CT狭窄更不容易受到CT伪影的影响）有效排除引起缺血的病变的能力接近100%。事实上，这些结果在随后的FFR CT对中度狭窄严重程度病变的前瞻性多中心研究中保持一致，其总体准确性、敏感性、特异性、阳性预测值和阴性预测值分别为80%、85%、79%、63%和92%。重要的是，到目前为止，其他无创影像学检查尚未评估中度狭窄的病变特异性缺血。
We thank Mao et al 1 for their thoughtful letter and their interest in our prospective, multicenter study demonstrating the high diagnostic performance of fractional flow reserve derived from computed tomography (FFR CT) to identify and exclude lesion-specific ischemia in intermediate stenosis. 2 Dr Mao et al 1 expressed 3 concerns with our study, which we address herein. First, Mao et al 1 assert that “the elasticity of arterial wall may greatly impact on the cardiac perfusion pressure in vivo, which was improperly neglected in the computation of FFR CT.” Although the latter of these statements is true, the former is simply not. FFR CT—similar to FFR itself—is a time-averaged quantity, and thus, arterial wall elasticity has negligible effects on the diagnostic performance of FFR CT.Second, for lesions of intermediate stenosis severity, which impart a non-negligible yet generally low rate of ischemia, a major goal of the diagnostic workup of patients with suspected ischemic heart disease is to effectively exclude patients who have ischemia-causing lesions. In the present study, the ability for FFR CT—a diagnostically robust calculation that is less susceptible to CT artifacts than the CT stenosis alone 3—to effectively exclude lesions that caused ischemia approached 100%. Indeed, these results remained consistent in a subsequent prospective, multicenter study of FFR CT for lesions of intermediate stenosis severity, which demonstrated an overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 80%, 85%, 79%, 63%, and 92%, respectively. 4 Importantly, lesion-specific ischemia of intermediate stenoses has not yet been evaluated for other noninvasive imaging tests to date.
影响因子：
11.3
作者：
Sarno, Giovanna;Decraemer, Isabel;Wijns, William
通讯作者：
Wijns, William
针对中度狭窄严重程度的冠状动脉病变的计算机断层扫描血管造影得出的无创血流储备分数：DeFACTO 研究的结果“对应”
DOI：
--
发表时间：
--
期刊：
影响因子：
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作者：
Y. Mao;X. Qi;Lin Zhou;References Nakazato;Park Hb;Berman Ds;Gransar H;Koo Bk;Erglis A;Lin Fy;Dunning Am;Budoff Mj;Malpeso J;Leipsic J;Min Jk Noninvasive;Min Jk;Pencina Mj;C. Van Mieghem;Apruzzese P;Cole Jh;Jaffe Fa;Leon Mb;Mancini Gb;Park Sj;Schwartz Rs;Shaw Lj;Mauri L;De Bruyne;Hamilos M Cuisset;Wyffels E;Bartunek J;Heyndrickx Gr;Wijns W;Morris Pd;Ryan D;Morton Ac;Lycett R;Lawford Pv;Hose Dr;Gunn
通讯作者：
Gunn