Stress myocardial perfusion with qualitative magnetic resonance and quantitative dynamic computed tomography: comparison of diagnostic performance and incremental value over coronary computed tomography angiography.

Autor:	de Knegt MC; Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark., Rossi A; Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK., Petersen SE; Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK., Wragg A; Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK., Khurram R; Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK., Westwood M; Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK., Saberwal B; Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK., Mathur A; Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK., Nieman K; Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA., Bamberg F; Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany., Jensen MT; Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.; Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark., Pugliese F; Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.
Jazyk:	angličtina
Zdroj:	European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2020 Oct 08. Date of Electronic Publication: 2020 Oct 08.
DOI:	10.1093/ehjci/jeaa270
Abstrakt:	Aims: Assessment of haemodynamically significant coronary artery disease (CAD) using cardiovascular magnetic resonance (CMR) imaging perfusion or dynamic stress myocardial perfusion imaging by computed tomography (CT perfusion) may aid patient selection for invasive coronary angiography (ICA). We evaluated the diagnostic performance and incremental value of qualitative CMR perfusion and quantitative CT perfusion complementary to cardiac computed tomography angiography (CCTA) for the diagnosis of haemodynamically significant CAD using fractional flow reserve (FFR) and quantitative coronary angiography (QCA) as reference standard. Methods and Results: CCTA, qualitative visual CMR perfusion, visual CT perfusion, and quantitative relative myocardial blood flow (CT-MBF) were performed in patients with stable angina pectoris. FFR was measured in coronary vessels with stenosis visually estimated between 30% and 90% diameter reduction on ICA. Haemodynamically significant CAD was defined as FFR <0.80, or QCA ≥80% in those cases where FFR could not be performed. A total of 218 vessels from 93 patients were assessed. An optimal cut-off of 0.72 for relative CT-MBF was determined. The diagnostic performances (area under the receiver-operating characteristics curves, 95% CI) of visual CMR perfusion (0.84, 0.77-0.90) and relative CT-MBF (0.86, 0.81-0.92) were comparable and outperformed visual CT perfusion (0.64, 0.57-0.71). In combination with CCTA ≥50%, CCTA + visual CMR perfusion (0.91, 0.86-0.96), CCTA + relative CT-MBF (0.92, 0.88-0.96), and CCTA + visual CT perfusion (0.82, 0.75-0.90) improved discrimination compared with CCTA alone (all P < 0.05). Conclusion: Visual CMR perfusion and relative CT-MBF outperformed visual CT perfusion and provided incremental discrimination compared with CCTA alone for the diagnosis of haemodynamically significant CAD. (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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