Dynamic Myocardial Perfusion CT for the Detection of Hemodynamically Significant Coronary Artery Disease.

Autor:	Nous FMA; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands., Geisler T; Department of Cardiology, University of Tuebingen, Tuebingen, Germany., Kruk MBP; Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland., Alkadhi H; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Kitagawa K; Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan., Vliegenthart R; Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands., Hell MM; Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany., Hausleiter J; Department of Cardiology, Ludwig-Maximilians University, Munich, Germany., Nguyen PK; Veterans Affairs Palo Alto Healthcare System, Cardiology Section, Palo Alto, California, USA; Stanford University, Division of Cardiovascular Medicine, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford, California, USA., Budde RPJ; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands., Nikolaou K; Department of Radiology, University Hospital of Tübingen, Tübingen, Germany., Kepka C; Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland., Manka R; Department of Cardiology, University Heart Center and Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Sakuma H; Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan., Malik SB; Veterans Affairs Palo Alto Healthcare System, Thoracic and Cardiovascular Imaging Section, Palo Alto, California, USA; Stanford University, Division of Cardiovascular Imaging (Affiliated), Stanford, California, USA., Coenen A; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands., Zijlstra F; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands., Klotz E; Siemens Healthineers, Forcheim, Germany., van der Harst P; Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands., Artzner C; Department of Cardiology, University of Tuebingen, Tuebingen, Germany., Dedic A; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands., Pugliese F; Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts National Institute for Health Research Biomedical Research Centre, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom., Bamberg F; Department of Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany., Nieman K; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Stanford University School of Medicine and Cardiovascular Institute, Stanford, California, USA. Electronic address: koennieman@hotmail.com.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2022 Jan; Vol. 15 (1), pp. 75-87. Date of Electronic Publication: 2021 Sep 15.
DOI:	10.1016/j.jcmg.2021.07.021
Abstrakt:	Objectives: In this international, multicenter study, using third-generation dual-source computed tomography (CT), we investigated the diagnostic performance of dynamic stress CT myocardial perfusion imaging (CT-MPI) in addition to coronary CT angiography (CTA) compared to invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR). Background: CT-MPI combined with coronary CTA integrates coronary artery anatomy with inducible myocardial ischemia, showing promising results for the diagnosis of hemodynamically significant coronary artery disease in single-center studies. Methods: At 9 centers in Europe, Japan, and the United States, 132 patients scheduled for ICA were enrolled; 114 patients successfully completed coronary CTA, adenosine-stress dynamic CT-MPI, and ICA. Invasive FFR was performed in vessels with 25% to 90% stenosis. Data were analyzed by independent core laboratories. For the primary analysis, for each coronary artery the presence of hemodynamically significant obstruction was interpreted by coronary CTA with CT-MPI compared to coronary CTA alone, using an FFR of ≤0.80 and angiographic severity as reference. Territorial absolute myocardial blood flow (MBF) and relative MBF were compared using C-statistics. Results: ICA and FFR identified hemodynamically significant stenoses in 74 of 289 coronary vessels (26%). Coronary CTA with ≥50% stenosis demonstrated a per-vessel sensitivity, specificity, and accuracy for the detection of hemodynamically significant stenosis of 96% (95% CI: 91%-100%), 72% (95% CI: 66%-78%), and 78% (95% CI: 73%-83%), respectively. Coronary CTA with CT-MPI showed a lower sensitivity (84%; 95% CI: 75%-92%) but higher specificity (89%; 95% CI: 85%-93%) and accuracy (88%; 95% CI: 84%-92%). The areas under the receiver-operating characteristic curve of absolute MBF and relative MBF were 0.79 (95% CI: 0.71-0.86) and 0.82 (95% CI: 0.74-0.88), respectively. The median dose-length product of CT-MPI and coronary CTA were 313 mGy·cm and 138 mGy·cm, respectively. Conclusions: Dynamic CT-MPI offers incremental diagnostic value over coronary CTA alone for the identification of hemodynamically significant coronary artery disease. Generalized results from this multicenter study encourage broader consideration of dynamic CT-MPI in clinical practice. (Dynamic Stress Perfusion CT for Detection of Inducible Myocardial Ischemia [SPECIFIC]; NCT02810795). Competing Interests: Funding Support and Author Disclosures This study was supported by unrestricted grants from Siemens Healthineers and Bayer Healthcare. Dr Nguyen’s research is supported by the National Institutes of Health (R01HL134830-01). Koen Nieman’s research is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (R01HL141712; R01HL146754). Dr Geisler has received research grants from Medtronic and Edwards Lifesciences. Dr Kitagawa has received an endowed chair position supported by Siemens Healthineers. Dr Vliegenthart has received an institutional research grant from Siemens Healthineers. Dr Hausleiter has received receiving speaker honoraria and research support from Abbott Vascular and Edwards Lifesciences; and has served as a consultant for Edwards Lifesciences. Dr Pugliese has received research support from Siemens Healthineers. Dr Budde has received institutional research support to the Erasmus MC from Siemens Healthineers. Dr Nikolauo has received research grants from Siemens Healthineers, GE Healthcare, and Bayer Healthcare; and has served as a consultant for Siemens Healthineers; and Bayer Healthcare. Dr Sakuma has received departmental research grants from FUJIFILM Toyama Chemical Co, Ltd, and Guerbet Japan KK. Dr Klotz is a retired employee of and serves as a consultant for Siemens Healthineers. Dr Bamberg has received research grants from Siemens Healthineers and Bayer Healthcare; and has served as a consultant for Siemens Healthineers, Bayer Healthcare, and Bracco. Dr Nieman has received unrestricted institutional research support from Siemens Healthineers and HeartFlow Inc; has served as a consultant for Siemens Medical Systems USA; and holds equity in Lumen Therapeutics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
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