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Dynamic Myocardial Perfusion CT for the Detection of Hemodynamically Significant Coronary Artery Disease. JACC. Cardiovascular imaging Nous, F. M., Geisler, T., Kruk, M. B., Alkadhi, H., Kitagawa, K., Vliegenthart, R., Hell, M. M., Hausleiter, J., Nguyen, P. K., Budde, R. P., Nikolaou, K., Kepka, C., Manka, R., Sakuma, H., Malik, S. B., Coenen, A., Zijlstra, F., Klotz, E., van der Harst, P., Artzner, C., Dedic, A., Pugliese, F., Bamberg, F., Nieman, K. 2021

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 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).

View details for DOI 10.1016/j.jcmg.2021.07.021

View details for PubMedID 34538630