Nuclear stress perfusion imaging versus computed tomography coronary angiography for identifying patients with obstructive coronary artery disease as defined by conventional angiography: insights from the CorE-64 multicenter study
Nuclear stress perfusion imaging versus computed tomography coronary angiography for identifying patients with obstructive coronary artery disease as defined by conventional angiography: insights from the CorE-64 multicenter study
复制标题
核应力灌注成像与计算机断层扫描冠状动脉造影用于识别传统血管造影定义的阻塞性冠状动脉疾病患者：CorE-64 多中心研究的见解
DOI：
10.5301/heart.2014.12493
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发表时间：
2014
影响因子：
0.2
通讯作者：
A. Arbab
中科院分区：
文献类型：
--
作者：
Y. Tanami;Julie M. Miller;A. Vavere;C. Rochitte;M. Dewey;H. Niinuma;M. Clouse;Christopher Cox;J. Brinker;J. Lima;A. Arbab
我们研究了计算机断层血管造影（CTA）与心肌灌注成像（MPI）检测常规定量冠状动脉造影（QCA）定义的阻塞性冠状动脉疾病（CAD）的诊断准确性。63名入选CorE-64多中心研究的患者接受了CTA、MPI和QCA成像。所有疑似或已知冠状动脉疾病的受试者均接受心导管检查。采用受试者工作特征（ROC）分析评价定量CTA和MPI对QCA鉴别冠状动脉狭窄50%及以上患者的诊断准确性。预先定义的亚组是已知的CAD患者和钙评分在400或以上的患者。ROC分析的诊断准确性显示，在所有63例患者中，CTA的曲线下面积（AUC）均大于MPI：分别为0.95[95%可信区间（CI）： 0.89-0.100]和0.65 (95%CI: 0.53-0.77) （P<0.01）。CTA的敏感性、特异性、阳性预测值和阴性预测值分别为0.93、0.95、0.97、0.88，MPI的敏感性、特异性和阳性预测值分别为0.85、0.45、0.74、0.63。在48例无已知CAD的患者中，CTA的AUC为0.96，SPECT的AUC为0.67 （P<0.01）。钙评分低于400和高于400的患者，CTA的AUC差异无统计学意义（0.93 vs 0.95），但SPECT的AUC差异有统计学意义（0.61 vs 0.95， P<0.01）。在直接比较中，CTA在检测患者阻塞性冠状动脉疾病方面明显优于MPI。即使在传统上对CTA更具挑战性的亚组中，SPECT也不能提供类似的良好诊断准确性。如果诊断阻塞性CAD的目的是成像，CTA可以被认为是一种非侵入性的检查选择。
We investigated the diagnostic accuracy of computed tomography angiography (CTA) versus myocardial perfusion imaging (MPI) for detecting obstructive coronary artery disease (CAD) as defined by conventional quantitative coronary angiography (QCA). Sixty-three patients who were enrolled in the CorE-64 multicenter study underwent CTA, MPI, and QCA imaging. All subjects were referred for cardiac catheterization with suspected or known coronary artery disease. The diagnostic accuracy of quantitative CTA and MPI for identifying patients with 50% or greater coronary arterial stenosis by QCA was evaluated using receiver operating characteristic (ROC) analysis. Pre-defined subgroups were patients with known CAD and those with a calcium score of 400 or over. Diagnostic accuracy by ROC analysis revealed greater area under the curve (AUC) for CTA than MPI for all 63 patients: 0.95 [95% confidence interval (CI): 0.89-0.100] vs 0.65 (95%CI: 0.53-0.77), respectively (P<0.01). Sensitivity, specificity, positive and negative predictive values were 0.93, 0.95, 0.97, 0.88, respectively, for CTA and 0.85, 0.45, 0.74, 0.63, respectively, for MPI. In 48 patients without known CAD, AUC was 0.96 for CTA and to 0.67 for SPECT (P<0.01). There was no significant difference in AUC for CTA in patients with calcium score below 400 versus over 400 (0.93 vs 0.95), but AUC was different for SPECT (0.61 vs 0.95; P<0.01). In a direct comparison, CTA is markedly superior to MPI for detecting obstructive coronary artery disease in patients. Even in subgroups traditionally more challenging for CTA, SPECT does not offer similarly good diagnostic accuracy. CTA may be considered the non-invasive test of choice if diagnosis of obstructive CAD is the purpose of imaging.