Data for comparison of computed tomography angiography and dynamic myocardial perfusion to detect significant stenosis by coronary angiography

Background Heavy coronary artery calcification (CAC) impairs diagnostic accuracy of coronary computed tomography angiography (cCTA) and is considered to be a major limitation. Purpose To investigate the effect of non-evaluable CAC seen on cCTA on clinical decision-making by determining the degree of subsequent invasive testing and to assess the relationship between non-evaluable segments containing CAC and significant stenosis as seen in invasive coronary angiography (ICA). Material and Methods The study comprised of 356 patients who underwent cCTA and subsequent ICA within 2 months between 2005 and 2009. Clinical reports were reviewed to identify the indications for referral to ICA. In a subset of 68 patients where non-diagnostic CAC on cCTA and significant stenosis on ICA were present in the same segment, we correlated and analyzed the underlying stenosis severity of the lesion on ICA to the cCTA. Lesions with CAC were analyzed in a standardized fashion by application of reading rules. Results Non-diagnostic CAC on cCTA prompted ICA in 5.6% of patients. CAC occurred at the site of maximum stenosis in segments with stenosis <50% (95.9% [47/49]), 50–69% (82.4% [28/34]), 70–99% (64.5% [31/48]), and 100% (33.3% [1/3]). At the point of maximum calcium deposit, non-obstructive disease was present in 61.2%. Application of reading rules resulted in a 44% reduction in non-diagnostic cCTA reads. Conclusion Severe CAC may prompt further investigation with ICA. There is less CAC with increasing lesion severity at the point of maximum stenosis. Additional application of reading rules improved non-diagnostic cCTA reads.

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PROGNOSTIC VALUE OF CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY, MYOCARDIAL PERFUSION IMAGING AND INVASIVE CORONARY ANGIOGRAPHY IN KIDNEY TRANSPLANTATION CANDIDATES: A PROSPECTIVE COHORT STUDY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)34487-x ◽

2017 ◽

Vol 69 (11) ◽

pp. 1098 ◽

Cited By ~ 2

Author(s):

Simon Winther ◽

My Svensson ◽

Hanne S. Jørgensen ◽

Laust D. Rasmussen ◽

Lars Gormsen ◽

...

Keyword(s):

Computed Tomography ◽

Cohort Study ◽

Kidney Transplantation ◽

Myocardial Perfusion Imaging ◽

Coronary Angiography ◽

Myocardial Perfusion ◽

Computed Tomography Angiography ◽

Prognostic Value ◽

Coronary Computed Tomography Angiography ◽

Invasive Coronary Angiography

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Stress myocardial perfusion with qualitative magnetic resonance and quantitative dynamic computed tomography: comparison of diagnostic performance and incremental value over coronary computed tomography angiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa270 ◽

2020 ◽

Author(s):

Martina C de Knegt ◽

Alexia Rossi ◽

Steffen E Petersen ◽

Andrew Wragg ◽

Ruhaid Khurram ◽

...

Keyword(s):

Computed Tomography ◽

Magnetic Resonance ◽

Coronary Angiography ◽

Myocardial Perfusion ◽

Computed Tomography Angiography ◽

Diagnostic Performance ◽

Ct Perfusion ◽

Fractional Flow ◽

Stress Myocardial Perfusion ◽

Incremental Value

Abstract Aims Assessment of haemodynamically significant coronary artery disease (CAD) using cardiovascular magnetic resonance (CMR) imaging perfusion or dynamic stress myocardial perfusion imaging by computed tomography (CT perfusion) may aid patient selection for invasive coronary angiography (ICA). We evaluated the diagnostic performance and incremental value of qualitative CMR perfusion and quantitative CT perfusion complementary to cardiac computed tomography angiography (CCTA) for the diagnosis of haemodynamically significant CAD using fractional flow reserve (FFR) and quantitative coronary angiography (QCA) as reference standard. Methods and results CCTA, qualitative visual CMR perfusion, visual CT perfusion, and quantitative relative myocardial blood flow (CT-MBF) were performed in patients with stable angina pectoris. FFR was measured in coronary vessels with stenosis visually estimated between 30% and 90% diameter reduction on ICA. Haemodynamically significant CAD was defined as FFR <0.80, or QCA ≥80% in those cases where FFR could not be performed. A total of 218 vessels from 93 patients were assessed. An optimal cut-off of 0.72 for relative CT-MBF was determined. The diagnostic performances (area under the receiver-operating characteristics curves, 95% CI) of visual CMR perfusion (0.84, 0.77–0.90) and relative CT-MBF (0.86, 0.81–0.92) were comparable and outperformed visual CT perfusion (0.64, 0.57–0.71). In combination with CCTA ≥50%, CCTA + visual CMR perfusion (0.91, 0.86–0.96), CCTA + relative CT-MBF (0.92, 0.88–0.96), and CCTA + visual CT perfusion (0.82, 0.75–0.90) improved discrimination compared with CCTA alone (all P < 0.05). Conclusion Visual CMR perfusion and relative CT-MBF outperformed visual CT perfusion and provided incremental discrimination compared with CCTA alone for the diagnosis of haemodynamically significant CAD.

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The Potential Value of Hybrid Positron Emission Tomography/Dual-Source Computed Tomography Imaging in Coronary Bypass Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.20111045 ◽

2011 ◽

Vol 14 (5) ◽

pp. 283 ◽

Cited By ~ 2

Author(s):

Andre Plass ◽

Maximilian Y. Emmert ◽

Oliver Gaemperli ◽

Hatem Alkadhi ◽

Philipp Kaufmann ◽

...

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Coronary Artery ◽

Coronary Angiography ◽

Myocardial Perfusion ◽

Predictive Value ◽

Bypass Surgery ◽

Emission Tomography ◽

Positron Emission ◽

Pet Ct

Background: We evaluated how comprehensive assessment of coronary artery lesions and their hemodynamic relevance by means of hybrid positron emission tomography (PET) and computed tomography (CT) imaging would affect decision-making in coronary artery bypass surgery (CABG), compared with using invasive coronary angiography (ICA) alone.Methods: After undergoing ICA, 27 patients (21 men and 6 women; mean SD age, 66 � 10 years) planned for cardiac surgery were scheduled for myocardial perfusion stress/rest evaluation with [13N]ammonia PET and CT coronary angiography. Only ICA was available to the surgeon. Postoperatively, the performed CABG was compared with the hypothetical strategy based on hybrid PET/CT findings (regional coronary flow reserve [CFR], myocardial perfusion defects). Procedures included CABG (n = 18) alone, CABG combined with valve replacement (n = 6), and CABG combined with isolated valve replacement (n = 3). A total of 56 bypass grafts (28 venous and 28 arterial) and 66 distal anastomoses were placed.Results: CT evaluation showed 93% concordance (66/71) with ICA regarding significant stenoses, with sensitivity, specificity, positive predictive value, and negative predictive value of 93.1%, 98.7%, 94.4%, and 98.4%, respectively. In the PET scan, 16 patients had 1 ischemic region, and 12 patients had 1 scar region, including 5 patients who presented with mixed conditions (scar and ischemia). One patient had a completely normal myocardium. Compared with the performed surgery, PET/CT fusion evaluation showed that of the performed anastomoses, 48% had documented ischemia (with a CFR <2 in 86%), 38% were nonischemic (although a CFR value <2 was found in 78%), and 14% had scar tissue (fixed perfusion defect).Conclusions: Although <50% of bypasses were placed to areas with myocardial ischemia, the CFR was low in the majority of nonischemic regions, a finding that may have important prognostic relevance. PET/CT fusion imaging could potentially influence planning for CABG and provide incremental prognostic information.

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