The purpose of this study is to determine the diagnostic accuracy of MPICT for the detection of hemodynamically relevant coronary stenosis (as determined by invasive FFR) in patients with suspected or known CAD clinically referred for invasive angiography.
Rationale: Cardiac computed tomography (CT) provides accurate assessment of the coronary arteries and detects significant coronary stenosis with high diagnostic accuracy. However, the hemodynamic relevance of these stenotic lesion remains unclear, although highly relevant for clinical decision-making. Recent technical developments with third-generation dual-source CT allow to determine myocardial perfusion during hyperemia and thus for assessment of the hemodynamic relevance of coronary lesions using a dynamic acquisition mode. To date, there is only very limited evidence of the feasibility of this approach stemming from single-center studies with varying standards of reference. Objective: To determine the diagnostic accuracy of MPICT for the detection of hemodynamically relevant coronary stenosis (as determined by invasive FFR) in patients with suspected or known CAD clinically referred for invasive angiography. In an optional sub-study the diagnostic accuracy of MPICT for the detection of myocardial perfusion defects as determined by cardiac magnetic resonance imaging (CMRI) will be investigated. Study design: Observational cohort study with fractional flow reserve (FFR) during invasive angiography as the reference standard. Study population: Patients with known or suspected CAD clinically referred for invasive angiography. Main study parameters: Myocardial perfusion defect on dynamic CT perfusion imaging, and diagnostic accuracy as compared invasive FFR. Co Principle Investigators Koen Nieman MD PhD, Erasmus University Medical Center Fabian Bamberg MD PhD, University of Tübingen. Investigators Valerie Schmidt-Honndorf PhD, University of Tübingen Tobias Geisler MD PhD, University of Tübingen Joost Daemen MD PhD, Erasmus University Medical Center Adriaan Coenen MD, Erasmus University Medical Center Stephan Achenbach MD PhD, Erlangen University Micheala M. Hell MD, Erlangen University Rozemarijn Vliegenthart MD PhD, UMC Groningen Pim van der Harst MD PhD, UMC Groningen Francesca Pugliese MD PhD, Queen Mary University of London Kakuya Kitagawa MD PhD, Mie University Hatem Alkadhi MD PhD, University Hospital Zurich, Switzerland Robert Manka MD PhD, University Hospital Zurich, Switzerland
Study Type
OBSERVATIONAL
Enrollment
180
Myocardial perfusion defect on dynamic CT perfusion imaging, and diagnostic accuracy as compared invasive FFR.
ErasmusMC
Rotterdam, South Holland, Netherlands
Myocardial perfusion
invasive fractional flow reserve measurement
Time frame: For each patient within 4 weeks of the CT perfusion acquisition
Presence of myocardial perfusion defect on MPIMRI
Time frame: For each patient within 1 week before invasive fractional flow reserve measurement
Per patient assessment of hemodynamically significant CAD
Time frame: For each patient within 4 weeks of the CT perfusion acquisition
Ischemia per standardized myocardial segment
Time frame: For each patient within 4 weeks of the CT perfusion acquisition
Coronary stenosis by CTA per territory (branch)
Time frame: For each patient within 4 weeks of the CT perfusion acquisition
Coronary stenosis by invasive angiography per territory (branch)
Time frame: For each patient within 4 weeks of the CT perfusion acquisition
Demographics.
Time frame: For each patient within 1 week before invasive fractional flow reserve measurement
Cardiovascular risk factors
Time frame: For each patient within 1 week before invasive fractional flow reserve measurement
'Image quality, based on the DICOM images measured by experienced readers."
Time frame: Through study completion, an average of 1 to 2 years
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