European heart journal. Cardiovascular Imaging · 2026
Diagnostic yield of second-line functional imaging after an abnormal coronary computed tomography angiography: an individual patient-data meta-analysis.
СтатьяМетаанализНазвание и аннотация: Перевод в очереди
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Rasmussen Laust D, Hoek Roel, Westra Jelmer, Søby Jacob H, Maaniitty Teemu, Braathen Anders T, Saraste Antti, Isaksen Christin, Nissen Louise, Petersen Steffen E, Aakhus Svend, Knaapen Paul, Gormsen Lars C, Christiansen Evald H, Knuuti Juhani M, Bøttcher Morten, Driessen Roel S, Winther Simon
Аннотация
AIMS: Second-line functional imaging is recommended following an abnormal coronary computed tomography angiography (CCTA). However, evidence guiding the choice of imaging modality is limited. We assessed the diagnostic performance of second-line functional imaging using different invasive reference standards.
METHODS AND RESULTS: We conducted an individual patient-data meta-analysis of seven prospective diagnostic studies including 1410 patients (mean age 62 ± 8.1 years, 67% male) with abnormal CCTA [≥50% diameter stenosis (DS)], who underwent second-line functional imaging tests (dobutamine stress ECHO, SPECT, CMR, and/or PET) followed by invasive angiography with fractional flow reserve (FFR) and quantitative coronary angiography (QCA). Haemodynamically obstructive coronary artery disease (CAD) was defined as invasive FFR ≤0.80 or >90% visual DS; anatomically severe CAD as ≥70% DS by QCA. Pooled and per test, 904/1906 (47.2%) functional imaging tests had haemodynamically obstructive CAD, and 504/1906 (26.3%) functional imaging tests had anatomically severe CAD. In total, 730/1906 (38.3%) functional imaging tests were abnormal. Pooled sensitivity and specificity were 63% and 84% for haemodynamically obstructive CAD, and 81% and 77% for anatomically severe CAD. Findings were generally stable across sex and age. More advanced second-line functional imaging tests showed higher sensitivities, but lower specificities compared to less advanced techniques.
CONCLUSION: Second-line functional imaging after an abnormal CCTA enables identification of patients with anatomically severe CAD. In contrast, moderate stenoses (<70% DS) with FFR ≤0.80 do not consistently result in myocardial ischaemia detectable by functional imaging tests. Substantial diagnostic accuracy differences were found between non-invasive diagnostic test which need further investigation.
CLINICAL TRIAL IDENTIFIERS: NCT02264717, NCT03481712, NCT04707859, NCT01521468.
METHODS AND RESULTS: We conducted an individual patient-data meta-analysis of seven prospective diagnostic studies including 1410 patients (mean age 62 ± 8.1 years, 67% male) with abnormal CCTA [≥50% diameter stenosis (DS)], who underwent second-line functional imaging tests (dobutamine stress ECHO, SPECT, CMR, and/or PET) followed by invasive angiography with fractional flow reserve (FFR) and quantitative coronary angiography (QCA). Haemodynamically obstructive coronary artery disease (CAD) was defined as invasive FFR ≤0.80 or >90% visual DS; anatomically severe CAD as ≥70% DS by QCA. Pooled and per test, 904/1906 (47.2%) functional imaging tests had haemodynamically obstructive CAD, and 504/1906 (26.3%) functional imaging tests had anatomically severe CAD. In total, 730/1906 (38.3%) functional imaging tests were abnormal. Pooled sensitivity and specificity were 63% and 84% for haemodynamically obstructive CAD, and 81% and 77% for anatomically severe CAD. Findings were generally stable across sex and age. More advanced second-line functional imaging tests showed higher sensitivities, but lower specificities compared to less advanced techniques.
CONCLUSION: Second-line functional imaging after an abnormal CCTA enables identification of patients with anatomically severe CAD. In contrast, moderate stenoses (<70% DS) with FFR ≤0.80 do not consistently result in myocardial ischaemia detectable by functional imaging tests. Substantial diagnostic accuracy differences were found between non-invasive diagnostic test which need further investigation.
CLINICAL TRIAL IDENTIFIERS: NCT02264717, NCT03481712, NCT04707859, NCT01521468.