Dynamic Myocardial Perfusion CT for the Detection of Hemodynamically Significant Coronary Artery Disease
| Autor: | Adriaan Coenen, Kakuya Kitagawa, Rozemarijn Vliegenthart, Jörg Hausleiter, Koen Nieman, Ernst Klotz, Fabian Bamberg, Admir Dedic, Patricia K. Nguyen, Mariusz B.P. Kruk, C Artzner, Konstantin Nikolaou, Francesca Pugliese, Felix Zijlstra, Hatem Alkadhi, Hajime Sakuma, Fay M.A. Nous, Michaela M. Hell, Pim van der Harst, Sachin B. Malik, Robert Manka, Tobias Geisler, Cezary Kępka, Ricardo P.J. Budde |
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| Přispěvatelé: | Cardiology, Radiology & Nuclear Medicine, Cardiovascular Centre (CVC), Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), University of Zurich |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Computed Tomography Angiography 610 Medicine & health Fractional flow reserve Coronary Artery Disease Coronary Angiography Coronary artery disease Myocardial perfusion imaging Predictive Value of Tests Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Computed tomography angiography medicine.diagnostic_test business.industry 10042 Clinic for Diagnostic and Interventional Radiology Coronary Stenosis Myocardial Perfusion Imaging Blood flow medicine.disease Fractional Flow Reserve Myocardial Perfusion Stenosis medicine.anatomical_structure Cardiology 10209 Clinic for Cardiology Cardiology and Cardiovascular Medicine business Tomography X-Ray Computed Artery |
| Zdroj: | JACC: Cardiovascular Imaging, 15(1), 75-87. Elsevier Inc. JACC. Cardiovascular imaging, 15(1), 75-87. ELSEVIER SCIENCE INC |
| ISSN: | 1876-7591 1936-878X |
| Popis: | 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). |
| Databáze: | OpenAIRE |
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