CT Effective Identifying Coronary Heart Disease

Data from the Determination of Fractional Flow Reserve by Anatomic Computed Tomographic Angiography (DeFACTO) study were presented on August 26, 2012, at the European Society of Cardiology (ESC) Congress in Munich (Germany). John R. Lesser, MD, a cardiologist and senior researcher at the Minneapolis Heart Institute Foundation (MN, USA) served as a lead investigator for the DeFACTO study and Minneapolis Heart Institute Foundation cardiologist and senior researcher Robert Schwartz, MD, directed the Integration Core Lab coordinating data from 17 sites worldwide. The study’s findings were published online August 26, 2012, in the Journal of the American Medical Association (JAMA).

“The study showed improved diagnostic accuracy with CT scanning when we also use a new technique called fractional flow reserve that identifies the rate of coronary blood flow and possible blockages in the arteries that may interfere with flow,” said Dr. Schwartz.

Fractional flow reserve (FFR) has been identified as a procedure that may help to reduce unnecessary angiography and stenting when used. It requires a minimally invasive procedure. FFR with CT scanning requires no invasive procedure and has the potential to deliver equally useful data.

The goal of the DeFACTO study was to evaluate the diagnostic performance of CT with and without FFR for diagnosis of substantial coronary stenosis. In its conclusion, the use of noninvasive FFRCT among patients with CAD was associated with improved diagnostic accuracy and discrimination.

“DeFACTO is worthy of note because, while it did not achieve its endpoint, it definitely showed improved diagnostic accuracy using FFRCT vs. CT alone,” stated Dr. Schwartz. “We are always looking to use the least invasive procedures to get the best results and DeFACTO indicates that we may soon have another useful tool in evaluating and treating heart disease.”

In an editorial in the same issue of JAMA, Manesh R. Patel, MD, Duke Clinical Research Institute, Duke University Medical Center (Durham, NC, USA), wrote, “The current report describes an important noninvasive technology that may improve existing care and has the potential to outperform established noninvasive technologies.”

DeFACTO is a multicenter diagnostic performance study involving 252 stable patients with suspected or known CAD from 17 centers in five countries who underwent CT, invasive coronary angiography (ICA), FFR, and FFRCT between October 2010 and October 2011. The primary study outcome evaluated whether FFRCT plus CT could improve the per-patient diagnostic accuracy. Among study participants and compared with obstructive CAD diagnosed by CT alone, FFRCT was linked with improved diagnostic accuracy and discrimination.

The Minneapolis Heart Institute Foundation is focused creating a world without heart disease through clinical research and education programs.

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