Diagnostic Performance of Dynamic Myocardial Perfusion Imaging Using Dual-Source Computed Tomography.

Autor:	Kitagawa K; Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan. Electronic address: kakuya@med.mie-u.ac.jp., Nakamura S; Department of Radiology, Mie University Hospital, Tsu, Japan., Ota H; Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan., Ogawa R; Department of Radiology, Ehime University Graduate School of Medicine, Matsuyama, Japan., Shizuka T; Department of Cardiology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan., Kubo T; Department of Cardiovascular Medicine, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan., Yi Y; Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China., Ito T; Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan., Nagasawa N; Department of Radiology, Mie University Hospital, Tsu, Japan., Omori T; Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan., Nakamori S; Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan., Kurita T; Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan., Sugisawa J; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan., Hatori N; Department of Cardiology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan., Nakashima H; Department of Cardiovascular Medicine, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan., Wang Y; Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China., Kido T; Department of Radiology, Ehime University Graduate School of Medicine, Matsuyama, Japan., Watanabe K; Division of Cardiology, Saiseikai Matsuyama Hospital, Matsuyama, Japan., Matsumoto Y; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiovascular Medicine, Shioya Hospital, International University of Health and Welfare, Yaita, Japan., Dohi K; Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan., Sakuma H; Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2021 Nov 16; Vol. 78 (20), pp. 1937-1949.
DOI:	10.1016/j.jacc.2021.08.067
Abstrakt:	Background: Single-center studies indicated a high diagnostic accuracy of dynamic computed tomography perfusion (CTP) imaging in the diagnosis of coronary artery disease (CAD). Objectives: This prospective multicenter study determined the diagnostic performance of combined coronary computed tomography angiography (CTA) and CTP for detecting hemodynamically significant CAD defined by invasive coronary angiography (ICA) with fractional flow reserve (FFR). Methods: Seven centers enrolled 174 patients with suspected or known CAD who were clinically referred for ICA. CTA and dynamic CTP were performed using dual-source CT before ICA. FFR was done as part of ICA in the case of 26% to 90% coronary diameter stenosis. Hemodynamically significant stenosis was defined as FFR of <0.8 or >90% stenosis on ICA. Results: The study protocol was completed in 157 participants, and hemodynamically significant stenosis was detected in 76 of 157 patients (48%) and 112 of 442 vessels (25%). According to receiver-operating characteristic curve analysis, adding dynamic CTP to CTA significantly increased the area under the curve from 0.65 (95% CI: 0.57-0.72) to 0.74 (95% CI: 0.66-0.81; P = 0.011) on the patient level, with decreased sensitivity (93% vs 72%; P < 0.001), improved specificity (36% vs 75%; P < 0.001), and improved overall accuracy (64% vs 74%; P < 0.001). Conclusions: In this prospective multicenter study on dynamic CTP, the combination of anatomic assessment with coronary CTA and functional evaluation with dynamic CTP allowed more accurate identification of hemodynamically significant CAD compared with CTA alone. However, the clinical significance of this approach needs to be further investigated, including its usefulness in improving prognosis. (Assessment of Myocardial Perfusion Linked to Infarction and Fibrosis Explored With Dual-Source CT [AMPLIFiED]; UMIN000016353). Competing Interests: Funding Support and Author Disclosures Sponsored by Bayer Yakuhin, Ltd. The study sponsor was not involved in any stage of the study design, data acquisition, data analysis, or manuscript preparation. Dr Kitagawa is the Endowed Chair for Department of Advanced Diagnostic Imaging at Mie University Graduate School of Medicine funded by donations from Siemens Healthcare K.K. and FUJIFILM Medical Co, Ltd. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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