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Eur Heart J Cardiovasc Imaging. 2019 Jan 9. doi: 10.1093/ehjci/jey199. [Epub ahead of print]

Characterization of functionally significant coronary artery disease by a coronary computed tomography angiography-based index: a comparison with positron emission tomography.

Author information

Biomedical Research Foundation of Academy of Athens, 4 Soranou Ephesiou, Athens, Greece.
University of Ioannina, Materials Science and Engineering, Ioannina, Greece.
Biomedical Research Institute, FORTH, Ioannina, Greece.
Institute of Clinical Physiology, National Research Council, Pisa, IT, Italy.
First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University Medical School, Athens, Greece.
Turku PET Centre, Turku, Finland.
University of Ioannina Medical School Ioannina, Greece.
Department of Biomedical, Experimental and Clinical Sciences, Mario Serio, Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, Florence, FI, Italy.
Leiden University Medical Center, Leiden, Netherlands.
University Hospital Zurich, Zurich, Switzerland.
Fondazione Toscana Gabriele Monasterio, Pisa, IT, Italy.



To test the hypothesis that virtual functional assessment index (vFAI) is related with regional flow parameters derived by quantitative positron emission tomography (PET) and can be used to assess abnormal vasodilating capability in coronary vessels with stenotic lesions at coronary computed tomography angiography (CCTA).

Methods and results:

vFAI, stress myocardial blood flow (MBF), and myocardial flow reserve (MFR) were assessed in 78 patients (mean age 62.2 ± 7.7 years) with intermediate pre-test likelihood of coronary artery disease (CAD). Coronary stenoses ≥50% were considered angiographically significant. PET was considered positive for significant CAD, when more than one contiguous segments showed stress MBF ≤2.3 mL/g/min for 15O-water or <1.79 mL/g/min for 13N-ammonia. MFR thresholds were ≤2.5 and ≤2.0, respectively. vFAI was lower in vessels with abnormal stress MBF (0.76 ± 0.10 vs. 0.89 ± 0.07, P < 0.001) or MFR (0.80 ± 0.10 vs. 0.89 ± 0.07, P < 0.001). vFAI had an accuracy of 78.6% and 75% in unmasking abnormal stress MBF and MFR in 15O-water and 82.7% and 71.2% in 13N-ammonia studies, respectively. Addition of vFAI to anatomical CCTA data increased the ability for predicting abnormal stress MBF and MFR in 15O-water studies [AUCccta + vfai = 0.866, 95% confidence interval (CI) 0.783-0.949; P = 0.013 and AUCccta + vfai = 0.737, 95% CI 0.648-0.825; P = 0.007, respectively]. An incremental value was also demonstrated for prediction of stress MBF (AUCccta + vfai = 0.887, 95% CI 0.799-0.974; P = 0.001) in 13N-ammonia studies. A similar trend was recorded for MFR (AUCccta + vfai = 0.780, 95% CI 0.632-0.929; P = 0.13).


vFAI identifies accurately the presence of impaired vasodilating capability. In combination with anatomical data, vFAI enhances the diagnostic performance of CCTA.


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