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 Ito, 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

647 Citations (Scopus)

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
Externally publishedYes

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of '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)'. Together they form a unique fingerprint.

  • Cite this

    Nørgaard, B. L., Leipsic, J., Gaur, S., Seneviratne, S., Ko, B. S., Ito, H., Jensen, J. M., Mauri, L., De Bruyne, B., Bezerra, H., Osawa, K., Marwan, M., Naber, C., Erglis, A., Park, S. J., Christiansen, E. H., Kaltoft, A., Lassen, J. F., Bøtker, H. E., & 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, 63(12), 1145-1155. https://doi.org/10.1016/j.jacc.2013.11.043