scholarly journals Characterization of functionally significant coronary artery disease by a coronary computed tomography angiography-based index: a comparison with positron emission tomography

2019 ◽  
Vol 20 (8) ◽  
pp. 897-905 ◽  
Author(s):  
Constantinos D Anagnostopoulos ◽  
Panagiotis K Siogkas ◽  
Riccardo Liga ◽  
Georgios Benetos ◽  
Teemu Maaniitty ◽  
...  

Abstract Aims To test the hypothesis that virtual functional assessment index (vFAI) is related with regional flow parameters derived by quantitative positron emission tomography (PET) and can be used to assess abnormal vasodilating capability in coronary vessels with stenotic lesions at coronary computed tomography angiography (CCTA). Methods and results vFAI, stress myocardial blood flow (MBF), and myocardial flow reserve (MFR) were assessed in 78 patients (mean age 62.2 ± 7.7 years) with intermediate pre-test likelihood of coronary artery disease (CAD). Coronary stenoses ≥50% were considered angiographically significant. PET was considered positive for significant CAD, when more than one contiguous segments showed stress MBF ≤2.3 mL/g/min for 15O-water or <1.79 mL/g/min for 13N-ammonia. MFR thresholds were ≤2.5 and ≤2.0, respectively. vFAI was lower in vessels with abnormal stress MBF (0.76 ± 0.10 vs. 0.89 ± 0.07, P < 0.001) or MFR (0.80 ± 0.10 vs. 0.89 ± 0.07, P < 0.001). vFAI had an accuracy of 78.6% and 75% in unmasking abnormal stress MBF and MFR in 15O-water and 82.7% and 71.2% in 13N-ammonia studies, respectively. Addition of vFAI to anatomical CCTA data increased the ability for predicting abnormal stress MBF and MFR in 15O-water studies [AUCccta + vfai = 0.866, 95% confidence interval (CI) 0.783–0.949; P = 0.013 and AUCccta + vfai = 0.737, 95% CI 0.648–0.825; P = 0.007, respectively]. An incremental value was also demonstrated for prediction of stress MBF (AUCccta + vfai = 0.887, 95% CI 0.799–0.974; P = 0.001) in 13N-ammonia studies. A similar trend was recorded for MFR (AUCccta + vfai = 0.780, 95% CI 0.632–0.929; P = 0.13). Conclusion vFAI identifies accurately the presence of impaired vasodilating capability. In combination with anatomical data, vFAI enhances the diagnostic performance of CCTA.

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Teemu Maaniitty ◽  
Iida Soukka ◽  
Antti Saraste ◽  
Valtteri Uusitalo ◽  
Heikki Ukkonen ◽  
...  

Objectives: Hybrid imaging using coronary computed tomography angiography (CTA) and positron emission tomography (PET) perfusion imaging accurately detects functionally significant coronary artery disease (CAD), but its optimal clinical use remains unknown. We studied the prognostic significance of strategy utilizing sequential CTA for exclusion of CAD followed by PET perfusion imaging for evaluating functional significance of any suspected obstructive lesions with a hybrid PET-CT device in symptomatic patients with suspected intermediate probability of CAD. Methods: We identified a cohort of 864 consecutive patients undergone hybrid PET-CT for the detection of suspected CAD. All patients had CTA and based on CTA findings, haemodynamic significance of any suspected stenoses was evaluated by PET perfusion imaging using H 2 15 O during adenosine-induced stress. Major adverse cardiac events (MACE) including death, myocardial infarction (MI) and unstable angina pectoris (UAP), were collected from the national healthcare statistics. Results: After exclusion of 97 patients undergone early (< 6 months) revascularization, 767 patients with age of 61 ± 10 years (41% males) were followed-up for a median time of 2.5 years. During the follow-up 6 deaths, 5 MIs and 3 UAPs occurred. In 462 patients, obstructive CAD was excluded based on CTA alone and the remaining patients with suspected stenoses (n=305, 39.8%) underwent PET perfusion imaging. In patients with normal or non-obstructive CTA annual incidence of MACE was only 0.16%, whereas in patients with suspected stenosis based on CTA it was 1.36% (p<0.05 vs. no stenosis). In patients with suspected obstructive lesion based on CTA, patients with normal PET perfusion had significantly lower event rate than patients with ischemia (0.54 vs. 2.78%, p<0.05). Conclusion: In patients with suspected obstructive CAD PET perfusion imaging after CT angiography is able to accurately identify those patients with high risk of future MACE. Sequential use of CTA and PET perfusion imaging appears powerful and safe strategy for targeting therapeutic procedures in high risk individuals.


Author(s):  
Po-Yi Li ◽  
Ru-Yih Chen ◽  
Fu-Zong Wu ◽  
Guang-Yuan Mar ◽  
Ming-Ting Wu ◽  
...  

The objective of this study was to determine how coronary computed tomography angiography (CCTA) can be employed to detect coronary artery disease in hospital employees, enabling early treatment and minimizing damage. All employees of our hospital were assessed using the Framingham Risk Score. Those with a 10-year risk of myocardial infarction or death of >10% were offered CCTA; the Coronary Artery Disease Reporting and Data System (CAD-RADS) score was the outcome. A total of 3923 hospital employees were included, and the number who had received CCTA was 309. Among these 309, 31 (10.0%) had a CAD-RADS score of 3–5, with 10 of the 31 (32.3%) requiring further cardiac catheterization; 161 (52.1%) had a score of 1–2; and 117 (37.9%) had a score of 0. In the multivariate logistic regression, only age of ≥ 55 years (p < 0.05), hypertension (p < 0.05), and hyperlipidemia (p < 0.05) were discovered to be significant risk factors for a CAD-RADS score of 3–5. Thus, regular and adequate control of chronic diseases is critical for patients, and more studies are required to be confirmed if there are more significant risk factors.


Author(s):  
Lara Luiza Silvello Pereira ◽  
Gisele Marochi de Moraes ◽  
Adriano Camargo de Castro Carneiro ◽  
Valéria de Melo Moreira ◽  
Juliana Hiromi Silva Matsumoto Bello ◽  
...  

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