The Diagnostic Performance of QFR and Perfusion Imaging in Patients with Prior Coronary Artery Disease
Pepijn A van Diemen, Ruben W de Winter, Stefan P Schumacher, Henk Everaars, Michiel J Bom, Ruurt A Jukema, Yvemarie B Somsen, Pieter G Raijmakers, Rolf A Kooistra, Janny Timmer, Teemu Maaniitty, Lourens F Robbers, Martin B von Bartheld, Ahmet Demirkiran, Albert C van Rossum, Johan H Reiber, Juhani Knuuti, Richard S Underwood, Eike Nagel, Paul Knaapen, Roel S Driessen, Ibrahim Danad- Cardiology and Cardiovascular Medicine
- Radiology, Nuclear Medicine and imaging
- General Medicine
Abstract
Aims
In chronic coronary syndrome (CCS) patients with documented coronary artery disease (CAD) ischemia detection by myocardial perfusion imaging (MPI) or an invasive approach are viable diagnostic strategies. We compared the diagnostic performance of quantitative flow ratio (QFR) with single-photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance imaging (CMR) in patients with prior CAD (previous percutaneous coronary intervention (PCI) and/or myocardial infarction (MI)).
Methods and results
This PACIFIC-2 substudy evaluated 189 CCS patients with prior CAD for inclusion. Patients underwent SPECT, PET, and CMR followed by invasive coronary angiography with fractional flow reserve measurements of all major coronary arteries (N=567) except for vessels with a subtotal or chronic total occlusion. QFR computation was attempted in 488 (86%) vessels with measured FFR available (FFR ≤0.80 defined hemodynamically significant CAD). QFR analysis was successful in 334 (68%) vessels among 166 patients and demonstrated a higher accuracy (84%) and sensitivity (72%) compared to SPECT (66%, p<0.001 and 46%, p=0.001), PET (65%, p<0.001 and 58%, p=0.032), and CMR (72%, p<0.001 and 33%, p<0.001). Specificity of QFR (87%) was similar to CMR (83%, p=0.123) but higher than that of SPECT (71%, p<0.001) and PET (67%, p<0.001). Lastly, QFR exhibited a higher area under the receiver operating characteristic curve (0.89) than SPECT (0.57, p<0.001), PET (0.66, p<0.001), and CMR (0.60, p<0.001).
Conclusion
QFR correlated better with FFR in patients with prior CAD than MPI, as reflected in the higher diagnostic performance measures for detecting FFR-defined vessel-specific significant CAD.