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ORIGINAL ARTICLE
Year : 2020  |  Volume : 5  |  Issue : 1  |  Page : 33-41

Diagnostic performance of coronary computed tomography angiography-derived instantaneous wave-free ratio for myocardial bridge


1 Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University; Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
2 Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China

Correspondence Address:
Dr. Chang Sheng Zhou
Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu
China
Prof. Long Jiang Zhang
Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cp.cp_6_20

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Purpose: The purpose of the study was to investigate the diagnostic performance of instantaneous wave-free ratio (iFR) based on coronary computed tomography (CT) angiography (CCTA) (iFRCT) for a myocardial bridge (MB). Materials and Methods: One hundred and fourteen patients with 115 MBs from 9 Chinese medical centers were prospectively included in this study. All patients underwent CCTA and subsequent invasive coronary angiography with fractional flow reserve (FFR). iFRCTs were measured at 2–4 cm distal to the lesions. Diagnostic performance of iFRCT was assessed using Bland–Altman analysis with invasive FFR as the reference in the entire sample, as well as in subgroups based on MB depth and length. Results: iFRCT has 0.90 sensitivity (95% confidence interval: 0.75–0.97), 0.73 specificity (0.62–0.83), and 0.79 accuracy (0.70–0.86) in the overall analysis. None of the three measures (sensitivity, specificity, and accuracy) differed significantly between superficial (≤2 mm) and deep MB, short (≤30 mm) and long MB, or low (<70% diameter occlusion) and high stenosis (P > 0.05 for all). However, positive predictive value was lower in the low stenosis (<70%) group (0.37 [0.20–0.58] vs. 0.90 [0.72–0.97] in the high stenosis group, P < 0.001). Negative predictive value, in contrast, was higher in the low stenosis group (0.98 [0.87–1.00] vs. 0.75 [0.43–0.93], P = 0.024). The Bland–Altman analysis showed a slight difference between iFRCT and invasive FFR (0.04 in the overall analysis and all subgroup analyses, with an exception of 0.05 in the long MB subgroup). Conclusion: iFRCT has a high diagnostic performance in detecting MB related lesion-specific ischemia.


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