Incremental Prognostic Value of Myocardial Blood Flow Quantified With Stress Dynamic Computed Tomography Perfusion Imaging

Nakamura, Satoshi; Kitagawa, Kakuya; Goto, Yoshitaka; Omori, Taku; Kurita, Tairo; Yamada, A.; Takafuji, Masafumi; Uno, Mio; Dohi, Kaoru; Sakuma, Hajime

doi:10.1016/j.jcmg.2018.05.021

Cited by 48 publications

(30 citation statements)

References 21 publications

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“…Importantly, in the 2-year follow-up of the CORE320 study 161 , the combination of CT angiography and semiquantitative CT perfusion showed similar accuracy in predicting cardiovascular events to invasive coro nary angiography and SPECT combined. In another single-centre study, MBF derived from dynamic CT perfusion had independent predictive value, with a hazard ratio of 5.7 when adjusted for obstructive coronary artery disease on CT angiography 162 .…”

Section: Key Points For Echocardiographymentioning

confidence: 92%

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

et al. 2020

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International guidelines advocate noninvasive testing for patients with suspected ischaemia before proceeding with revascularization decision-making 1-4. Noninvasive clinical cardiac imaging continues to undergo rapid evolution, focusing on quantitative perfusion technologies for the assessment of myocardial ischaemia and coronary flow. At present, imaging of myocardial ischaemia stands at a crossroads. During a European meeting on quantitative cardiac imaging, a bench-to-bedside-to-bench perspective was used to summarize the current status and future potential of myocardial ischaemia imaging from the viewpoint of basic scientists and clinical researchers. This approach created discussions, which led to this Consensus Statement on the main advantages and disadvantages of each imaging modality, a clinical consensus on the appropriateness for specific indications and a summary of the latest developments, which together provide a framework for future quantitative imaging of myocardial ischaemia. Pathophysiology considerations The coronary circulation comprises the epicardial conductance vessels (diameter 1-6 mm) feeding an extensive network of small vessels (diameter <300-400 μm) that penetrates the cardiac muscle tissue and is the site of regulation of myocardial blood flow (MBF; Fig. 1a,b). High-resolution 3D fluorescence cryomicrotome imaging 5 has also revealed the existence of abundant small

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Section: Key Points For Echocardiographymentioning

confidence: 92%

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

et al. 2020

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“…The CRESCENT-II trial indicated that incorporation of dynamic CTP imaging as part of a tiered diagnostic approach could improve the clinical value and efficiency of cardiac CT in the diagnostic work-up of patients with stable CAD and was an effective alternative to standard guideline-directed functional testing [93]. Both static and dynamic CTP has also been reported to have incremental predictive value over clinical risk factors and CTA in assessment for future major adverse cardiac events (MACE) [94,95]. Dynamic CTP was shown to have higher prognostic value for MACE than CTA and CT-FFR, independent of clinical risk factors [96].…”

Section: Current Evidence Of Ctpmentioning

confidence: 99%

Computed tomographic evaluation of myocardial ischemia

et al. 2020

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Myocardial ischemia is caused by a mismatch between myocardial oxygen consumption and oxygen delivery in coronary artery disease (CAD). Stratification and decision-making based on ischemia improves the prognosis in patients with CAD. Non-invasive tests used to evaluate myocardial ischemia include stress electrocardiography, echocardiography, single-photon emission computed tomography, and magnetic resonance imaging. Invasive fractional flow reserve is considered the reference standard for assessment of the hemodynamic significance of CAD. Computed tomography (CT) angiography has emerged as a first-line imaging modality for evaluation of CAD, particularly in the population at low to intermediate risk, because of its high negative predictive value; however, CT angiography does not provide information on the hemodynamic significance of stenosis, which lowers its specificity. Emerging techniques, e.g., CT perfusion and CT-fractional flow reserve, help to address this limitation of CT, by determining the hemodynamic significance of coronary artery stenosis. CT perfusion involves acquisition during the first pass of contrast medium through the myocardium following pharmacological stress. CTfractional flow reserve uses computational fluid dynamics to model coronary flow, pressure, and resistance. In this article, we review these two functional CT techniques in the evaluation of myocardial ischemia, including their principles, technology, advantages, limitations, pitfalls, and the current evidence.

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“…Stress dynamic CTP was performed with adenosine triphosphate administration and injection of 40 mL (an iodine concentration of 370 mgI/mL) of iopamidol (Iopamiron 370; Bayer-Schering Pharma, Berlin, Germany) at a flow rate of 5 mL/s 17 . Dynamic data sets were acquired for 30 s via an electrocardiographically triggered axial scan mode, repeated at 2 alternating table positions.…”

Section: Methodsmentioning

confidence: 99%

“…Global MBF was calculated as the mean of the 16 segments. Severity of myocardial ischemia was evaluated using a summed stress score (SSS) 17 . A normalized MBF value was calculated as an MBF value in each segment divided by the highest MBF value within the 16 segments on an MBF map, then SSS was calculated by adding scores of all segments using a 5-point scale based on normalized MBF values: 0 = normal (> 0.75); 1 = mildly abnormal (≤ 0.75, > 0.675); 2 = moderately abnormal (≤ 0.675, > 0.60); and 3 = severely abnormal (≤ 0.60).…”

Section: Methodsmentioning

confidence: 99%

Quantification of extracellular volume fraction by cardiac computed tomography for noninvasive assessment of myocardial fibrosis in hemodialysis patients

Yamada

Kitagawa

Nakamura

et al. 2020

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Extent of myocardial fibrosis in hemodialysis patients has been associated with poor prognosis. Myocardial extracellular volume (ECV) quantification using contrast enhanced cardiac computed tomography (CT) is a novel method to determine extent of myocardial fibrosis. Cardiac CT-based myocardial ECV in hemodialysis patients with those of propensity-matched non-hemodialysis control subjects were compared. Twenty hemodialysis patients (mean age, 67.4 ± 9.6 years; 80% male) and 20 propensity-matched non-hemodialysis controls (mean age, 66.3 ± 9.1 years; 85% male) who underwent comprehensive cardiac CT consisted of calcium scoring, coronary CT angiography, stress perfusion CT and delayed enhancement CT were evaluated. Myocardial ECV was significantly greater in the hemodialysis group than in the control group (33.8 ± 4.7% versus 26.6 ± 2.9%; P < 0.0001). In the hemodialysis group, modest correlation was evident between myocardial ECV and left atrial volume index (r = 0.54; P = 0.01), while there was no correlation between myocardial ECV and other cardiac parameters including left ventricular mass index and severity of myocardial ischemia. Cardiac CT-based myocardial ECV may offer a potential imaging biomarker for myocardial fibrosis in HD patients.

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Incremental Prognostic Value of Myocardial Blood Flow Quantified With Stress Dynamic Computed Tomography Perfusion Imaging

Abstract: MBF quantified with dynamic CTP has an incremental prognostic value over CTA. The addition of dynamic CTP to CTA allows improved risk stratification of patients with CTA-detected stenosis.

Cited by 48 publications

References 21 publications

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

Computed tomographic evaluation of myocardial ischemia

Quantification of extracellular volume fraction by cardiac computed tomography for noninvasive assessment of myocardial fibrosis in hemodialysis patients

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