0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Noninvasive Approach to Assess Coronary Artery Stenoses and Ischemia

Nils P. Johnson, MD, MS; Richard L. Kirkeeide, PhD; K. Lance Gould, MD
JAMA. 2013;309(3):233-236. doi:10.1001/jama.2012.157189.
Text Size: A A A
Published online

Extract

To the Editor: Modeling FFR using CT angiograms represents the latest of many attempts to predict physiology from anatomy alone. All such techniques over the last 40 years (eg, percentage diameter stenosis, minimum lumen area or diameter, and stenosis flow reserve) have shown reasonable group agreement but unacceptable imprecision for individual application.

A large scatter between FFR and FFRCT most likely existed in the DeFACTO study,1 although it was not explicit in the article, leaving readers to infer its existence from the tables comparing dichotomized FFR and FFRCT. At best, the paired plot of FFR and FFRCT would mirror the results of the Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve (DISCOVER-FLOW) trial,2 which showed wide limits of agreement between FFRCT and FFR of ±0.13 in addition to a slight bias of −0.02 (underestimation by FFRCT) and correlation of 0.72. The discordance may be even larger in the DeFACTO study because per-patient accuracy (73% vs 87%) and specificity (54% vs 82%) were lower than in the DISCOVER-FLOW study.

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

January 16, 2013
Marc Dewey, MD; Oliver Gaemperli, MD; Peter Schlattmann, MD, PhD
JAMA. 2013;309(3):233-236. doi:10.1001/jama.2012.157199.
January 16, 2013
Jonathan Lessick, MD, DSc; Doron Aronson, MD
JAMA. 2013;309(3):233-236. doi:10.1001/jama.2012.157195.
January 16, 2013
Neng Dai, MD; Harry Hua-Xiang Xia, PhD, MMed; Ya-Wei Xu, MD, PhD
JAMA. 2013;309(3):233-236. doi:10.1001/jama.2012.157192.
January 16, 2013
James K. Min, MD
JAMA. 2013;309(3):233-236. doi:10.1001/jama.2012.157208.
CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Jobs
brightcove.createExperiences();