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

Nous, Fay M. A.; Geisler, Tobias; Kruk, Mariusz B. P.; Alkadhi, Hatem; Kitagawa, Kakuya; Vliegenthart, Rozemarijn; Hell, Michaela M.; Hausleiter, Jörg; Nguyen, Patricia K.; Budde, Ricardo P. J.; Nikolaou, Konstantin; Kepka, Cezary; Manka, Robert; Sakuma, Hajime; Malik, Sachin B.; Coenen, Adriaan; Zijlstra, Felix; Klotz, Ernst; Harst, Pim van der; Artzner, Christoph; Dedic, Admir; Pugliese, Francesca; Bamberg, Fabian und Nieman, Koen (2022): Dynamic Myocardial Perfusion CT for the Detection of Hemodynamically Significant Coronary Artery Disease. In: JACC Cardiovascular Imaging, Bd. 15, Nr. 1: S. 75-87

Abstract

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 cor-onary 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 hemody-namically 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 center dot cm and 138 mGy center dot 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) (J Am Coll Cardiol Img 2022;15:75-87) (c) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1936-878X
• Sprache: Englisch