Please cite this article in press as: Ramos V, et al. Noninvasive anatomical and functional assessment of coronary artery disease. Rev Port Cardiol. 2015. http://dx.doi.org/10.1016/j.repc.2014.10.008 ARTICLE IN PRESS +Model REPC-618; No. of Pages 10 Rev Port Cardiol. 2015;xxx(xx):xxx---xxx www.revportcardiol.org Revista Portuguesa de Cardiologia Portuguese Journal of Cardiology ORIGINAL ARTICLE Noninvasive anatomical and functional assessment of coronary artery disease Vítor Ramos a,* , Nuno Bettencourt b , Jennifer Silva b , Nuno Ferreira b , Amedeo Chiribiri c , Andreas Schuster d , Adelino Leite-Moreira e,f , José Silva-Cardoso e,f , Eike Nagel c , Vasco Gama b a Cardiology Department, Hospital de Braga, Portugal b Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal c Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom d Department of Cardiology and Pneumology and Heart Research Centre, Georg-August-University, Göttingen, Germany e Cardiology Department, Centro Hospitalar de S. João, Portugal f Faculty of Medicine, Porto University, Portugal Received 23 July 2014; accepted 10 October 2014 KEYWORDS Coronary artery disease; Fractional flow reserve; Computed tomography angiography; Cardiac magnetic resonance myocardial perfusion imaging; Integrated assessment Abstract Introduction and Objective: In suspected coronary artery disease (CAD), invasive coronary angiography (ICA) is traditionally the diagnostic tool of choice. However, patients often have no significant disease. Moreover, assessment of fractional flow reserve (FFR) has been shown to have prognostic implications. Recently, coronary computed tomography angiography (CTA) and cardiac magnetic resonance (CMR) myocardial perfusion imaging (CMR-Perf) have gained increasing attention through their accurate anatomical and functional assessment, respectively. We studied the added value of integrating these tests (CT+CMRint) in the diagnosis of CAD, with FFR as the reference standard. Methods: We included 101 patients consecutively referred for outpatient assessment of CAD who underwent CTA and CMR-Perf prior to ICA with FFR assessment. Lesions were considered positive by CT+CMRint only if positive in the two tests alone. The mean follow-up was 2.9± 0.6 years. Results: All patients completed the study protocol without adverse effects. Forty-four patients had CAD by FFR. CTA had excellent sensitivity and negative predictive value (100%) but, as expected, its specificity and positive predictive value were lower (61% and 67%, respectively). Diagnostic accuracy by FFR was 78% for CTA, 88% for CMR-Perf and 92% for CT+CMRint. Regarding diagnostic accuracy, CT+CMRint showed statistically significant superiority (AUC=0.917, 95% CI 0.845---0.963) compared with CTA (AUC=0.807, 95% CI 0.716---0.879, p=0.0057) or CMR-Perf (AUC=0.882, 95% CI 0.802---0.938, p=0.0398) alone. Regarding prediction of revascularization, the integrated protocol maintained its superior performance. ∗ Corresponding author. E-mail address: vglramos@gmail.com (V. Ramos). http://dx.doi.org/10.1016/j.repc.2014.10.008 0870-2551/© 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. All rights reserved.