Functional stress imaging to predict abnormal coronary fractional flow reserve: the PACIFIC 2 study

van Rossum Albert C.; Boellaard Ronald; Nagel Eike; Tulevski Igor I.; Driessen Roel S.; Robbers Lourens F.H.J.; Underwood S Richard; Raijmakers Pieter G.; Somsen G. Aernout; Hofstra Leonard; von Bartheld Martin B.; Danad Ibrahim; Knuuti Juhani; van de Ven Peter M.; Demirkiran Ahmet; Maaniitty Teemu; Knaapen Paul; van Diemen Pepijn A.
Functional stress imaging to predict abnormal coronary fractional flow reserve: the PACIFIC 2 study

van Rossum Albert C.
Boellaard Ronald
Nagel Eike
Tulevski Igor I.
Driessen Roel S.
Robbers Lourens F.H.J.
Underwood S Richard
Raijmakers Pieter G.
Somsen G. Aernout
Hofstra Leonard
von Bartheld Martin B.
Danad Ibrahim
Knuuti Juhani
van de Ven Peter M.
Demirkiran Ahmet
Maaniitty Teemu
Knaapen Paul
van Diemen Pepijn A.
Katso/Avaa
Lataukset: 

OXFORD UNIV PRESS
doi:10.1093/eurheartj/ehac286
URI
https://doi.org/10.1093/eurheartj/ehac286
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Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe2022102463124
Tiivistelmä

Aims
The diagnostic performance of non-invasive imaging in patients with prior coronary artery disease (CAD) has not been tested in prospective head-to-head comparative studies. The aim of this study was to compare the diagnostic performance of qualitative single-photon emission computed tomography (SPECT), quantitative positron emission tomography (PET), and qualitative magnetic resonance imaging (MRI) in patients with a prior myocardial infarction (MI) or percutaneous coronary intervention (PCI).

Methods and results
In this prospective clinical study, all patients with prior MI and/or PCI and new symptoms of ischaemic CAD underwent 99mTc-tetrofosmin SPECT, [15O]H2O PET, and MRI, followed by invasive coronary angiography with fractional flow reserve (FFR) in all coronary arteries. All modalities were interpreted by core laboratories. Haemodynamically significant CAD was defined by at least one coronary artery with an FFR ≤0.80. Among the 189 enrolled patients, 63% had significant CAD. Sensitivity was 67% (95% confidence interval 58–76%) for SPECT, 81% (72–87%) for PET, and 66% (56–75%) for MRI. Specificity was 61% (48–72%) for SPECT, 65% (53–76%) for PET, and 62% (49–74%) for MRI. Sensitivity of PET was higher than SPECT (P = 0.016) and MRI (P = 0.014), whereas specificity did not differ among the modalities. Diagnostic accuracy for PET (75%, 68–81%) did not statistically differ from SPECT (65%, 58–72%, P = 0.03) and MRI (64%, 57–72%, P = 0.052). Using FFR < 0.75 as a reference, accuracies increased to 69% (SPECT), 79% (PET), and 71% (MRI).

Conclusion
In this prospective head-to-head comparative study, SPECT, PET, and MRI did not show a significantly different accuracy for diagnosing FFR defined significant CAD in patients with prior PCI and/or MI. Overall diagnostic performances, however, were discouraging and the additive value of non-invasive imaging in this high-risk population is questionable.

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