Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: The NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps)

Bjarne L. Nørgaard, Jonathon Leipsic, Sara Gaur, Sujith Seneviratne, Brian S. Ko, Hiroshi Itoh, Jesper M. Jensen, Laura Mauri, Bernard De Bruyne, Hiram Bezerra, Kazuhiro Osawa, Mohamed Marwan, Christoph Naber, Andrejs Erglis, Seung Jung Park, Evald H. Christiansen, Anne Kaltoft, Jens F. Lassen, Hans Erik Bøtker, Stephan Achenbach

Research output: Contribution to journalArticle

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Abstract

Objectives The goal of this study was to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFR CT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD). Background FFR measured during invasive coronary angiography (ICA) is the gold standard for lesion-specific coronary revascularization decisions in patients with stable CAD. The potential for FFRCT to noninvasively identify ischemia in patients with suspected CAD has not been sufficiently investigated. Methods This prospective multicenter trial included 254 patients scheduled to undergo clinically indicated ICA for suspected CAD. Coronary CTA was performed before ICA. Evaluation of stenosis (>50% lumen reduction) in coronary CTA was performed by local investigators and in ICA by an independent core laboratory. FFR CT was calculated and interpreted in a blinded fashion by an independent core laboratory. Results were compared with invasively measured FFR, with ischemia defined as FFRCT or FFR ≤0.80. Results The area under the receiver-operating characteristic curve for FFR;bsubesub& was 0.90 (95% confidence interval [CI]: 0.87 to 0.94) versus 0.81 (95% CI: 0.76 to 0.87) for coronary CTA (p = 0.0008). Per-patient sensitivity and specificity (95% CI) to identify myocardial ischemia were 86% (95% CI: 77% to 92%) and 79% (95% CI: 72% to 84%) for FFR;bsubesub& versus 94% (86 to 97) and 34% (95% CI: 27% to 41%) for coronary CTA, and 64% (95% CI: 53% to 74%) and 83% (95% CI: 77% to 88%) for ICA, respectively. In patients (n = 235) with intermediate stenosis (95% CI: 30% to 70%), the diagnostic accuracy of FFR;bsubesub& remained high. Conclusions FFR;bsubesub& provides high diagnostic accuracy and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. When compared with anatomic testing by using coronary CTA,FFRled to a marked increase in specificity. (HeartFlowNXT-HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography [HFNXT]; NCT01757678).

Original languageEnglish
Pages (from-to)1145-1155
Number of pages11
JournalJournal of the American College of Cardiology
Volume63
Issue number12
DOIs
Publication statusPublished - Apr 1 2014

Fingerprint

Coronary Artery Disease
Confidence Intervals
Coronary Angiography
Myocardial Ischemia
Pathologic Constriction
Ischemia
Computed Tomography Angiography
ROC Curve
Multicenter Studies
Research Personnel
Sensitivity and Specificity

Keywords

  • computational fluid dynamics
  • coronary CT angiography
  • fractional flow reserve
  • invasive coronary angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease : The NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). / Nørgaard, Bjarne L.; Leipsic, Jonathon; Gaur, Sara; Seneviratne, Sujith; Ko, Brian S.; Itoh, Hiroshi; Jensen, Jesper M.; Mauri, Laura; De Bruyne, Bernard; Bezerra, Hiram; Osawa, Kazuhiro; Marwan, Mohamed; Naber, Christoph; Erglis, Andrejs; Park, Seung Jung; Christiansen, Evald H.; Kaltoft, Anne; Lassen, Jens F.; Bøtker, Hans Erik; Achenbach, Stephan.

In: Journal of the American College of Cardiology, Vol. 63, No. 12, 01.04.2014, p. 1145-1155.

Research output: Contribution to journalArticle

Nørgaard, BL, Leipsic, J, Gaur, S, Seneviratne, S, Ko, BS, Itoh, H, Jensen, JM, Mauri, L, De Bruyne, B, Bezerra, H, Osawa, K, Marwan, M, Naber, C, Erglis, A, Park, SJ, Christiansen, EH, Kaltoft, A, Lassen, JF, Bøtker, HE & Achenbach, S 2014, 'Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: The NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps)', Journal of the American College of Cardiology, vol. 63, no. 12, pp. 1145-1155. https://doi.org/10.1016/j.jacc.2013.11.043
Nørgaard, Bjarne L. ; Leipsic, Jonathon ; Gaur, Sara ; Seneviratne, Sujith ; Ko, Brian S. ; Itoh, Hiroshi ; Jensen, Jesper M. ; Mauri, Laura ; De Bruyne, Bernard ; Bezerra, Hiram ; Osawa, Kazuhiro ; Marwan, Mohamed ; Naber, Christoph ; Erglis, Andrejs ; Park, Seung Jung ; Christiansen, Evald H. ; Kaltoft, Anne ; Lassen, Jens F. ; Bøtker, Hans Erik ; Achenbach, Stephan. / Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease : The NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). In: Journal of the American College of Cardiology. 2014 ; Vol. 63, No. 12. pp. 1145-1155.
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abstract = "Objectives The goal of this study was to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFR CT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD). Background FFR measured during invasive coronary angiography (ICA) is the gold standard for lesion-specific coronary revascularization decisions in patients with stable CAD. The potential for FFRCT to noninvasively identify ischemia in patients with suspected CAD has not been sufficiently investigated. Methods This prospective multicenter trial included 254 patients scheduled to undergo clinically indicated ICA for suspected CAD. Coronary CTA was performed before ICA. Evaluation of stenosis (>50{\%} lumen reduction) in coronary CTA was performed by local investigators and in ICA by an independent core laboratory. FFR CT was calculated and interpreted in a blinded fashion by an independent core laboratory. Results were compared with invasively measured FFR, with ischemia defined as FFRCT or FFR ≤0.80. Results The area under the receiver-operating characteristic curve for FFR;bsubesub& was 0.90 (95{\%} confidence interval [CI]: 0.87 to 0.94) versus 0.81 (95{\%} CI: 0.76 to 0.87) for coronary CTA (p = 0.0008). Per-patient sensitivity and specificity (95{\%} CI) to identify myocardial ischemia were 86{\%} (95{\%} CI: 77{\%} to 92{\%}) and 79{\%} (95{\%} CI: 72{\%} to 84{\%}) for FFR;bsubesub& versus 94{\%} (86 to 97) and 34{\%} (95{\%} CI: 27{\%} to 41{\%}) for coronary CTA, and 64{\%} (95{\%} CI: 53{\%} to 74{\%}) and 83{\%} (95{\%} CI: 77{\%} to 88{\%}) for ICA, respectively. In patients (n = 235) with intermediate stenosis (95{\%} CI: 30{\%} to 70{\%}), the diagnostic accuracy of FFR;bsubesub& remained high. Conclusions FFR;bsubesub& provides high diagnostic accuracy and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. When compared with anatomic testing by using coronary CTA,FFRled to a marked increase in specificity. (HeartFlowNXT-HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography [HFNXT]; NCT01757678).",
keywords = "computational fluid dynamics, coronary CT angiography, fractional flow reserve, invasive coronary angiography",
author = "N{\o}rgaard, {Bjarne L.} and Jonathon Leipsic and Sara Gaur and Sujith Seneviratne and Ko, {Brian S.} and Hiroshi Itoh and Jensen, {Jesper M.} and Laura Mauri and {De Bruyne}, Bernard and Hiram Bezerra and Kazuhiro Osawa and Mohamed Marwan and Christoph Naber and Andrejs Erglis and Park, {Seung Jung} and Christiansen, {Evald H.} and Anne Kaltoft and Lassen, {Jens F.} and B{\o}tker, {Hans Erik} and Stephan Achenbach",
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TY - JOUR

T1 - Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease

T2 - The NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps)

AU - Nørgaard, Bjarne L.

AU - Leipsic, Jonathon

AU - Gaur, Sara

AU - Seneviratne, Sujith

AU - Ko, Brian S.

AU - Itoh, Hiroshi

AU - Jensen, Jesper M.

AU - Mauri, Laura

AU - De Bruyne, Bernard

AU - Bezerra, Hiram

AU - Osawa, Kazuhiro

AU - Marwan, Mohamed

AU - Naber, Christoph

AU - Erglis, Andrejs

AU - Park, Seung Jung

AU - Christiansen, Evald H.

AU - Kaltoft, Anne

AU - Lassen, Jens F.

AU - Bøtker, Hans Erik

AU - Achenbach, Stephan

PY - 2014/4/1

Y1 - 2014/4/1

N2 - Objectives The goal of this study was to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFR CT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD). Background FFR measured during invasive coronary angiography (ICA) is the gold standard for lesion-specific coronary revascularization decisions in patients with stable CAD. The potential for FFRCT to noninvasively identify ischemia in patients with suspected CAD has not been sufficiently investigated. Methods This prospective multicenter trial included 254 patients scheduled to undergo clinically indicated ICA for suspected CAD. Coronary CTA was performed before ICA. Evaluation of stenosis (>50% lumen reduction) in coronary CTA was performed by local investigators and in ICA by an independent core laboratory. FFR CT was calculated and interpreted in a blinded fashion by an independent core laboratory. Results were compared with invasively measured FFR, with ischemia defined as FFRCT or FFR ≤0.80. Results The area under the receiver-operating characteristic curve for FFR;bsubesub& was 0.90 (95% confidence interval [CI]: 0.87 to 0.94) versus 0.81 (95% CI: 0.76 to 0.87) for coronary CTA (p = 0.0008). Per-patient sensitivity and specificity (95% CI) to identify myocardial ischemia were 86% (95% CI: 77% to 92%) and 79% (95% CI: 72% to 84%) for FFR;bsubesub& versus 94% (86 to 97) and 34% (95% CI: 27% to 41%) for coronary CTA, and 64% (95% CI: 53% to 74%) and 83% (95% CI: 77% to 88%) for ICA, respectively. In patients (n = 235) with intermediate stenosis (95% CI: 30% to 70%), the diagnostic accuracy of FFR;bsubesub& remained high. Conclusions FFR;bsubesub& provides high diagnostic accuracy and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. When compared with anatomic testing by using coronary CTA,FFRled to a marked increase in specificity. (HeartFlowNXT-HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography [HFNXT]; NCT01757678).

AB - Objectives The goal of this study was to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFR CT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD). Background FFR measured during invasive coronary angiography (ICA) is the gold standard for lesion-specific coronary revascularization decisions in patients with stable CAD. The potential for FFRCT to noninvasively identify ischemia in patients with suspected CAD has not been sufficiently investigated. Methods This prospective multicenter trial included 254 patients scheduled to undergo clinically indicated ICA for suspected CAD. Coronary CTA was performed before ICA. Evaluation of stenosis (>50% lumen reduction) in coronary CTA was performed by local investigators and in ICA by an independent core laboratory. FFR CT was calculated and interpreted in a blinded fashion by an independent core laboratory. Results were compared with invasively measured FFR, with ischemia defined as FFRCT or FFR ≤0.80. Results The area under the receiver-operating characteristic curve for FFR;bsubesub& was 0.90 (95% confidence interval [CI]: 0.87 to 0.94) versus 0.81 (95% CI: 0.76 to 0.87) for coronary CTA (p = 0.0008). Per-patient sensitivity and specificity (95% CI) to identify myocardial ischemia were 86% (95% CI: 77% to 92%) and 79% (95% CI: 72% to 84%) for FFR;bsubesub& versus 94% (86 to 97) and 34% (95% CI: 27% to 41%) for coronary CTA, and 64% (95% CI: 53% to 74%) and 83% (95% CI: 77% to 88%) for ICA, respectively. In patients (n = 235) with intermediate stenosis (95% CI: 30% to 70%), the diagnostic accuracy of FFR;bsubesub& remained high. Conclusions FFR;bsubesub& provides high diagnostic accuracy and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. When compared with anatomic testing by using coronary CTA,FFRled to a marked increase in specificity. (HeartFlowNXT-HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography [HFNXT]; NCT01757678).

KW - computational fluid dynamics

KW - coronary CT angiography

KW - fractional flow reserve

KW - invasive coronary angiography

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