Additional diagnostic value of new CT imaging techniques for the functional assessment of coronary artery disease: a meta-analysis
To determine the diagnostic performance of cardiac computed tomography (CT)–based modalities including coronary CT angiography (CTA), stress myocardial CT perfusion (stress CTP), computer simulation of fractional flow reserve by CT (FFRCT), and transluminal attenuation gradients (TAG), for the diagnosis of hemodynamic significant coronary artery disease (CAD), using invasive fractional flow reserve as the reference standard.
PubMed and Cochrane databases were searched for original articles until July 2018. Diagnostic accuracy results were pooled at per-patient and per-vessel level using random effect models.
Fifty articles were included in the meta-analysis (3024 subjects). The per-patient analysis per imaging modality demonstrated a pooled positive likelihood ratio (PLR) of 1.78 (95% confidence interval CI 1.49–2.11), 4.58 (95% CI 3.54–5.91), and 3.45 (95% CI 2.38–5.00) for CTA, stress CTP, and FFRCT respectively. Per-patient specificity of stress CTP (82%, 95% CI 76–86) and FFRCT (72%, 95% CI 68–76) were higher than for CTA (48%, 95% CI 44–51). At the vessel level, PLR was 2.42 (95% CI 1.93–3.02), 7.72 (95% CI 5.50–10.83), 3.50 (95% CI 2.73–4.78), 1.97 (95% CI 1.32–2.93) for CTA, stress CTP, FFRCT, and TAG respectively.
With improved PLR and specificity, stress CTP and FFRCT have incremental value over CTA for the detection of functionally significant CAD.
• New functional CT imaging techniques, such as stress CTP and FFRCT, improve diagnostic accuracy of coronary CTA to predict hemodynamically relevant stenosis.
• TAG yields poor diagnostic performance.
• Combination of CTA and some functional CT techniques (stress CTP and FFRCT) might become a “must” to improve diagnostic accuracy of CAD and to reduce unnecessary invasive coronary angiography.
KeywordsCoronary angiography Myocardial perfusion imaging Computed tomography angiography Myocardial fractional flow reserve Coronary artery disease
Area under the curve
Coronary artery bypass grafting
Coronary artery disease
Coronary computed tomography angiography
Computed tomography perfusion
Computer simulation of fractional flow reserve based on computed tomography
Invasive fractional flow reserve
Negative likelihood ratio
Negative predictive value
Positive likelihood ratio
Positive predictive value
Transluminal attenuation gradient
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Dr. Michele Hamon (M.D.).
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise.
Written informed consent was not required for this study because it is a meta-analysis.
Institutional Review Board approval was not required because it is a meta-analysis.
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