Prognostic Value of Computed Tomography-Derived Fractional Flow Reserve Comparison With Myocardial Perfusion Imaging,JACC: Cardiovascular Imaging

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Prognostic Value of Computed Tomography-Derived Fractional Flow Reserve Comparison With Myocardial Perfusion Imaging
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2021-10-13 , DOI: 10.1016/j.jcmg.2021.09.007
Ahmed Ibrahim Ahmed ₁ , Yushui Han ₁ , Mahmoud Al Rifai ₂ , Talal Alnabelsi ₁ , Faisal Nabi ₁ , Su Min Chang ₁ , Myra Cocker ₃ , Chris Schwemmer ₄ , Juan C Ramirez-Giraldo ₅ , Neal S Kleiman ₁ , William A Zoghbi ₁ , John J Mahmarian ₁ , Mouaz H Al-Mallah ₁

Affiliation

Objectives

The aim of this study was to compare the incremental prognostic value of coronary computed tomography (CT) angiography (CCTA)-derived machine learning fractional flow reserve CT (ML-FFRct) versus that of ischemia detected on single-photon emission-computed tomography (SPECT) myocardial perfusion imaging (MPI) on incident cardiovascular outcomes.

Background

SPECT MPI and ML-FFRct are noninvasive tools that can assess the hemodynamic significance of coronary atherosclerotic disease.

Methods

We studied a retrospective cohort of consecutive patients who underwent clinically indicated CCTA and SPECT MPI. ML-FFRct was computed using a ML prototype. The primary outcome was all-cause mortality and nonfatal myocardial infarction (D/MI), and the secondary outcome was D/MI and unplanned revascularization, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) occurring more than 90 days postimaging. Multiple nested multivariate cox regression was used to model a scenario wherein an initial anatomical assessment was followed by a functional assessment.

Results

A total of 471 patients (mean age: 64 ± 13 year; 53% males) were included. Comorbidities were prevalent (78% hypertension, 66% diabetes, 81% dyslipidemia). ML-FFRct was <0.8 in at least 1 proximal/midsegment was present in 41.6% of patients, and ischemia on MPI was present in 13.8%. After a median follow-up of 18 months, 7% of patients (n = 33) experienced D/MI. On multivariate Cox proportional analysis, the presence of ischemia on MPI but not ML-FFRct significantly predicted D/MI (HR: 2.3; 95% CI: 1.0-5.0; P = 0.047; or HR: 0.7; 95% CI: 0.3-1.4; P = 0.306 respectively) when added to CCTA obstructive stenosis. Furthermore, the model with SPECT ischemia had higher global chi-square result and significantly improved reclassification. Results were similar using the secondary outcome and on several sensitivity analyses.

Conclusions

In a high-risk patient cohort, SPECT MPI but not ML-FFRct adds independent and incremental prognostic information to CCTA-based anatomical assessment and clinical risk factors in predicting incident outcomes.

中文翻译：

计算机断层扫描衍生的血流储备分数与心肌灌注成像比较的预后价值

目标

本研究的目的是比较冠状动脉计算机断层扫描 (CT) 血管造影 (CCTA) 衍生的机器学习血流储备分数 CT (ML-FFRct) 与单光子发射计算机断层扫描检测到的缺血的增量预后价值。 SPECT) 心肌灌注成像 (MPI) 对心血管事件的影响。

背景

SPECT MPI 和 ML-FFRct 是可以评估冠状动脉粥样硬化疾病的血流动力学意义的非侵入性工具。

方法

我们研究了一个连续患者的回顾性队列，这些患者接受了有临床指征的 CCTA 和 SPECT MPI。ML-FFRct 是使用 ML 原型计算的。主要结局是全因死亡率和非致死性心肌梗死 (D/MI)，次要结局是 D/MI 和非计划血运重建、经皮冠状动脉介入治疗 (PCI) 或冠状动脉旁路移植术 (CABG) 发生在成像后 90 天以上. 使用多重嵌套多变量 cox 回归来模拟一个场景，其中初始解剖评估之后是功能评估。

结果

共纳入 471 名患者（平均年龄：64 ± 13 岁；53% 为男性）。合并症很普遍（78% 的高血压，66% 的糖尿病，81% 的血脂异常）。41.6% 的患者存在至少 1 个近端/中段的 ML-FFRct <0.8，13.8% 的患者存在 MPI 缺血。中位随访 18 个月后，7% 的患者 (n = 33) 出现 D/MI。在多变量 Cox 比例分析中，MPI 上存在缺血而非 ML-FFRct 可显着预测 D/MI（HR：2.3；95% CI：1.0-5.0；P = 0.047；或 HR：0.7；95% CI：0.3- 1.4；P =分别为 0.306）当添加到 CCTA 阻塞性狭窄时。此外，具有 SPECT 缺血的模型具有更高的全局卡方结果并显着改善了重新分类。使用次要结果和几项敏感性分析的结果相似。