Abstract
Background
The diagnostic performance of coronary computed tomography angiography-derived fractional
flow reserve (CT-FFR) in detecting ischemia in myocardial bridging (MB) has not been
investigated to date.
Methods
This retrospective multicentre study included 104 patients with left anterior descending
MBs. MB was classified as either superficial or deep, short, or long, whereas all
MB vessels were further divided into <50%, 50% to 69%, and ≥70% groups, according
to proximal lumen stenosis on invasive coronary angiography. Diagnostic performance
and receiver operating characteristics (ROC) of CT-FFR to detect lesion-specific ischemia
was assessed on a per-vessel level, using invasive FFR as reference standard. Intraclass
correlation coefficient (ICC) and Bland-Altman plots were used for agreement measurement.
Results
Forty-eight MB vessels (46.2%) showed ischemia by invasive FFR (≤0.80). Sensitivity,
specificity, and accuracy of CT-FFR to detect functional ischemia were 0.96 (0.85
to 0.99), 0.84 (0.71 to 0.92), and 0.89 (0.81 to 0.94), respectively, in all MB vessels.
There were no differences in diagnostic performance between superficial and deep MB
or between short and long MB (all P > 0.05). The accuracy of CT-FFR was 0.96 (0.85 to 0.99) in ≥70% stenosis, 0.82 (0.67
to 0.91) in 50% to 69% stenosis, and 0.89 (0.51 to 0.99) in <50% stenosis (P = 0.081). Bland-Altman analysis showed a slight mean difference between CT-FFR and
invasive FFR of 0.014 (95% limit of agreement, –0.117 to 0.145). The ICC was 0.775
(95% confidence interval, 0.685-0.842, P < 0.001).
Conclusions
CT-FFR demonstrated high diagnostic performance for identifying functional ischemia
in vessels with MB and concomitant proximal atherosclerotic disease when compared
with invasive FFR. However, the clinical use of CT-FFR in patients with MB needs further
study for stronger and more robust results.
Résumé
Contexte
L'efficacité diagnostique de la mesure de la réserve de flux coronaire (FFR, pour
fractional flow reserve) par coronarographie par tomodensitométrie à déceler une ischémie causée par un pont
myocardique n'a pas encore été étudiée.
Méthodologie
Cette étude multicentrique rétrospective regroupait 104 patients présentant un pont
myocardique au niveau de l'artère interventriculaire antérieure. Les ponts myocardiques
étaient classés comme superficiels ou profonds, courts ou longs, tandis que tous les
vaisseaux présentant un pont myocardique étaient quant à eux classés dans les groupes
< 50 %, 50 % à 69 %, et ≥ 70 % en fonction de la sténose proximale observée à la coronarographie
invasive. L'efficacité diagnostique et la courbe ROC (pour receiver operating characteristics) de la mesure de la réserve de flux coronaire à détecter une ischémie propre à une
lésion ont été évaluées en fonction des vaisseaux atteints, en utilisant la mesure
invasive de la réserve de flux coronaire comme norme de référence. Le coefficient
de corrélation intra-classe et des graphiques de Bland-Altman ont été utilisés pour
mesurer la concordance.
Résultats
La mesure invasive de la réserve de flux coronaire a révélé une ischémie dans 48 vaisseaux
présentant un pont myocardique (46,2 %) (≤ 0,80). La sensibilité, la spécificité et
la précision de la mesure de la réserve de flux coronaire par coronarographie par
tomodensitométrie à détecter une ischémie fonctionnelle étaient de 0,96 (0,85 à 0,99),
0,84 (0,71 à 0,92) et 0,89 (0,81 à 0,94), respectivement, pour tous les vaisseaux
présentant un pont myocardique. Aucune différence n'a été observée quant à l'efficacité
diagnostique entre les ponts myocardiques superficiels et profonds, ou entre les ponts
myocardiques courts et longs (valeur p > 0,05 dans tous les cas). La précision de la mesure de la réserve de flux coronaire
par coronarographie par tomodensitométrie était de 0,96 (0,85 à 0,99) dans le cas
d'une sténose ≥ 70 %, de 0,82 (0,67 à 0,91) dans celui d'une sténose de 50 % à 69
%, et de 0,89 (0,51 à 0,99) dans celui d'une sténose < 50 % (p = 0,081). L'analyse de Bland-Altman a révélé une différence moyenne légère de 0,014
entre la mesure de la réserve de flux coronaire par coronarographie par tomodensitométrie
et la mesure invasive de la réserve de flux coronaire (limites de concordance à 95
%, –0,117 à 0,145). Le coefficient de corrélation intra-classe était de 0,775 (intervalle
de confiance à 95 %, 0,685-0,842; p < 0,001).
Conclusions
La mesure de la réserve de flux coronaire par coronarographie par tomodensitométrie
a été associée à une efficacité diagnostique élevée pour ce qui est du repérage d'une
ischémie fonctionnelle au niveau des vaisseaux présentant un pont myocardique et de
l'athérosclérose proximale concomitante, comparativement à la mesure invasive de la
réserve de flux coronaire. L'utilisation en pratique clinique de la mesure de la réserve
de flux coronaire par coronarographie par tomodensitométrie chez les patients présentant
un pont myocardique doit toutefois faire l'objet d'études plus approfondies afin d'obtenir
des résultats plus probants.
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Article info
Publication history
Published online: August 27, 2019
Accepted:
August 21,
2019
Received:
June 29,
2019
Footnotes
See page 1532 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
