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

Nous FMA, Geisler T, Kruk MBP, Alkadhi H, Kitagawa K, Vliegenthart R, Hell M, Hausleiter J, Nguyen PK, Budde RPJ, Nikolaou K, Kepka C, Manka R, Sakuma H, Malik SB, Coenen A, Zijlstra F, Klotz E, Van Der Harst P, Artzner C, Dedic A, Pugliese F, Bamberg F, Nieman K (2022)

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Publication Type: Journal article

Publication year: 2022

Journal

Book Volume: 15

Pages Range: 75-87

Journal Issue: 1

DOI: 10.1016/j.jcmg.2021.07.021

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/).

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How to cite

APA:

Nous, F.M.A., Geisler, T., Kruk, M.B.P., Alkadhi, H., Kitagawa, K., Vliegenthart, R.,... Nieman, K. (2022). Dynamic Myocardial Perfusion CT for the Detection of Hemodynamically Significant Coronary Artery Disease. Journal of the American College of Cardiology : Cardiovascular imaging, 15(1), 75-87. https://doi.org/10.1016/j.jcmg.2021.07.021

MLA:

Nous, Fay M. A., et al. "Dynamic Myocardial Perfusion CT for the Detection of Hemodynamically Significant Coronary Artery Disease." Journal of the American College of Cardiology : Cardiovascular imaging 15.1 (2022): 75-87.

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