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January 16, 2013

Noninvasive Approach to Assess Coronary Artery Stenoses and Ischemia—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliation: Cedars-Sinai Heart Institute, Los Angeles, California (james.min@cshs.org).

JAMA. 2013;309(3):233-236. doi:10.1001/jama.2012.157208

In Reply: Dr Dewey and colleagues asked about discrimination of ischemia by FFRCT vs CT. Discrimination was determined by area under the receiver operating characteristic curves, which was higher for FFRCT than stenosis by CT on a per-patient and per-vessel basis (P < .001 for both). We are currently analyzing diagnostic accuracy including uninterpretable results.

Drs Lessick and Aronson inquired as to blinded integration of FFR and CT, which was needed to avoid the possibility of selection bias for determining FFRCT. Because CT-based computational models provide a 3-dimensional FFRCT in all coronary vessels, comparison of FFRCT with FFR required overlay at the location of the sensor wire used to measure FFR. Model construction and FFRCT were uniformly complete prior to integration.1