2018 EHJCI (Qualitative vs. Quantitative stress CTP)

Aims To compare the diagnostic accuracy of stress computed tomography myocardial perfusion (CTP) for the detection
of significant coronary artery disease with visual approach vs. quantitative analysis with transmural perfusion ratio
(TPR) in consecutive symptomatic patients scheduled for invasive coronary angiography (ICA) plus invasive fractional
flow reserve (FFR).
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Methods
and results
Eighty-eight consecutive symptomatic patients underwent rest coronary computed tomography angiography (cCTA)
followed by static stress-CTP. Diagnostic accuracy of cCTA þ stress-CTP with visual evaluation and with TPR measurement
was calculated and compared with ICA and invasive FFR. Addition of stress-CTP with qualitative evaluation
to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy at a vessel and patient
level of 92%, 92%, 97%, 82%, 92% and 98%, 80%, 97%, 82%, 89%, respectively indicating a significant improvement of
specificity, positive predictive value, and accuracy values vs. rest-cCTA in both models. Similarly, addition of stress-CTP
with TPR evaluation to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy
at a vessel and patient level of 84%, 90%, 93%, 76%, 88% and 91%, 71%, 89%, 75%, 81%, respectively indicating a significant
improvement of specificity, positive predictive value values vs. rest-cCTA only in a vessel-based model and of
positive predictive value in a patient-based model. When cCTA þ stress-CTP with qualitative evaluation was compared
with cCTA þ stress-CTP with TPR estimation, no differences were found in terms of diagnostic performance.
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Conclusion The addition of stress-CTP with visual evaluation to cCTA imaging has similar diagnostic performance when compared
with the quantitative analysis of myocardial perfusion based on TPR measurement.