The diagnostic performance of SPECT-MPI to predict functional significant coronary artery disease by fractional flow reserve derived from CCTA (FFRCT): sub-analysis from ACCURACY and VCT001 studies

Although single photon emission computed tomography-myocardial perfusion image (SPECT-MPI) and fractional flow reserve (FFR) derived from coronary computed tomographic angiography (CCTA) (FFRCT) have permitted functional assessment of coronary artery disease (CAD), the concordance between these modalities has not been well described. The aim of this study is to compare SPECT-MPI and anatomical stenosis by CCTA and invasive coronary angiography to FFRCT for assessing functional significance of CAD. We identified 62 patients with suspected CAD who underwent >= 64 slice coronary CTA and SPECT-MPI within 3 months. FFRCT was analyzed from CCTA data using the computational fluid dynamic techniques. The association between SPECT-MPI ischemia and FFRCT (<= 0.80) was evaluated. Out of 62 patients, 186 vessels were evaluated. On a per-vessel analysis, accuracy, sensitivity and specificity of SPECT-MPI to predict FFRCT <= 0.80 was 74.2, 45.0 and 77.7%, respectively. The area under the curve (AUC) by receiver-operating characteristic curve analysis for SPECT-MPI demonstrated a modest performance for predicting FFRCT <= 0.80 (AUC 0.56). Among patients with suspected CAD who were assessed by non-invasive functional modalities, SPECT-MPI showed modest concordance with FFRCT.