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

作者：Fay M. A. Nous, Tobias Geisler, Mariusz Kruk, Hatem Alkadhi, Kakuya Kitagawa, Rozemarijn Vliegenthart, Michaela M. Hell, Jörg Hausleiter, Patricia K. Nguyen, Ricardo P.J. Budde, Konstantin Nikolaou, Cezary Kępka, Robert Manka, Hajime Sakuma, Sachin B. Malik, Adriaan Coenen, Felix Zijlstra, Ernst Klotz, Pim van der Harst, Christoph Artzner, Admir Dedic, Francesca Pugliese, Fabian Bamberg, Koen Nieman · 发表于：JACC. Cardiovascular imaging · 年份：2021 · DOI：10.1016/j.jcmg.2021.07.021 · 被引用次数：101 · 研究领域：Cardiac Imaging and Diagnostics、Advanced X-ray and CT Imaging、Advanced MRI Techniques and Applications

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 s...