Dynamic Myocardial Perfusion CT for the Detection of Hemodynamically Significant Coronary Artery Disease.
Dynamic Myocardial Perfusion CT for the Detection of Hemodynamically Significant Coronary Artery Disease.
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DOI：
10.1016/j.jcmg.2021.07.021
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Nieman K
中科院分区：
文献类型：
--
作者：
Nous FMA;Geisler T;Kruk MBP;Alkadhi H;Kitagawa K;Vliegenthart R;Hell MM;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
在这项国际多中心研究中，我们使用第三代双源计算机断层扫描（CT），研究了动态负荷CT心肌灌注成像（CT-MPI）与冠状动脉CT血管造影（CTA）相比，有创冠状动脉血管造影（伊卡）和有创血流储备分数（FFR）的诊断性能。CT-MPI结合冠状动脉CTA将冠状动脉解剖与诱导性心肌缺血相结合，在单中心研究中显示出诊断血流动力学显著冠状动脉疾病的良好结果。在欧洲、日本和美国的9家临床试验机构，入组了132例计划接受伊卡的患者; 114例患者成功完成了冠状动脉CTA、腺苷负荷动态CT-MPI和伊卡。在25%-90%狭窄的血管中进行有创FFR。数据由独立核心实验室分析。对于主要分析，使用≤0.80的FFR和血管造影严重度作为参考，与单独冠状动脉CTA相比，通过冠状动脉CTA结合CT-MPI解释了每支冠状动脉存在血流动力学显著阻塞。局部绝对心肌血流量（MBF）和相对MBF使用C统计量进行比较。伊卡和FFR在289支冠状动脉血管中的74支（26%）中发现了血流动力学显著狭窄。狭窄≥50%的冠状动脉CTA显示，检测血流动力学显著狭窄的每支血管灵敏度、特异性和准确性分别为96%（95% CI：91-100）、72%（95% CI：66-78）和78%（95% CI：73-83）。CT-MPI的冠状动脉CTA显示出较低的敏感性（84%; 95% CI：75-92），但较高的特异性（89%; 95% CI：85-93）和准确性（88%; 95% CI：84-92）。绝对MBF和相对MBF的受试者工作特征曲线下面积分别为0.79（95%CI：0.71-0.86）和0.82（95%CI：0.74-0.88）。CT MPI和冠状动脉CTA的中位剂量长度乘积分别为313 mGy·cm和138 mGy·cm。动态CT-MPI在识别血流动力学显著性冠状动脉疾病方面提供了比单独冠状动脉CTA更高的诊断价值。这项多中心研究的一般结果鼓励在临床实践中更广泛地考虑动态CT-MPI。（用于检测诱导性心肌缺血的动态应力灌注CT [特定]; NCT 02810795）
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). 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. 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. 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. 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)
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3.5
作者：
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