Lesion-Specific Ischemia With Noninvasive Computed Tomographic Angiography

Shaw, Leslee J.; Nicol, Ed

doi:10.1001/jamacardio.2017.1315

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…CTP requires a high-end scanner, ideally with single heartbeat coverage and dedicated personnel, protocols, and postprocessing. CT-FFR can be obtained from CTA data from any scanner, but the images must be of high quality, the results are not available immediately, and there is an additional cost for using off-site CT-FFR technology [142]. Onsite systems are not commercially available as yet.…”

Section: Which Ct Imaging Technique Is Best For Ischemia?mentioning

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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Section: Which Ct Imaging Technique Is Best For Ischemia?mentioning

confidence: 99%

Computed tomographic evaluation of myocardial ischemia

et al. 2020

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“…While this review retains the important caveat of a lack of the individualized patient data provided by original study investigators, the authors were able to perform analyses assessing the accuracy of CT-FFR across a range of FFR values. As discussed by Shaw and Nicol, CT-FFR performed best at the outer ranges of FFR values rather than within the intermediate range of 0.7 to 0.8. Whether avoiding (or performing) angiography in patients with CT-FFR values within this range is safe/effective can only be determined through larger prospective studies that assess the clinical outcomes of these approaches.…”

mentioning

confidence: 78%

The Changing Paradigm for Assessment of Ischemic Coronary Artery Disease

Kirtane

2017

JAMA Cardiol

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For decades, the paradigm for assessing ischemic coronary artery disease has been a sequential approach of noninvasive functional testing followed by an anatomic delineation of the disease through invasive coronary assessments for appropriate patients. While this approach facilitates further prognostication for higher-risk patients while allowing lowerrisk patients to avoid invasive procedures, conventional noninvasive functional testing is not perfectly accurate. As such, not all patients who are higher risk based on functional testing have anatomically severe disease. Conversely, not all eligible patients with anatomically severe coronary artery disease are referred for a cardiac catheterization because of an underestimation of risk during upstream functional testing.The ability to combine anatomic and functional assessments in a single noninvasive test has the theoretical benefit of providing greater accuracy and confidence in risk stratification. Computed tomography (CT) angiography with adjunctive noninvasively assessed fractional flow reserve (FFR) derived through computational fluid dynamic modeling implements this approach to assessing coronary artery disease. Computed tomography with FFR adds diagnostic accuracy when compared with conventional CT angiography using the gold standard of invasively assessed FFR. 1

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“…CAD의 혈역학적 분석 기법인 CT-FFR와 CTP 중에 선택은 가용 자원과 인력에 크게 영향을 받는다( Table 5 ). CT-FFR은 대부분의 심장 CT에서 얻는 CCTA를 이용해 측정할 수 있지만, 화질이 좋아야 하며, 원격 CT-FFR을 사용하는 경우, 결과를 얻기까지 시간과 상당한 추가 비용이 발생한다( 132 ). 현장 CT-FFR은 반자동 시스템으로 특히 석회화가 심한 병변을 대상으로 수기 교정이 필요하다.…”

Section: 기능적 분석 기법의 비교와 선택unclassified

Beyond Coronary CT Angiography: CT Fractional Flow Reserve and Perfusion

Kim

Yang

Choo

et al. 2022

J Korean Soc Radiol

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심장 전산화단층촬영은 비약적인 기술발전과 다양한 연구 결과를 바탕으로 심혈관위험 계층화와 치료 결정을 위한 관상동맥 질환의 진단과 예후 평가성능이 입증되었다. 전산화단층촬영 관상동맥조영술은 폐쇄성 관상동맥 질환에 대한 음성 예측도가 높아서 침습적 혈관조영술의 빈도를 줄일 수 있는 관상동맥 질환 관련 검사의 관문으로 부상했지만, 진단특이도가 상대적으로 낮다. 하지만 심장 전산화단층촬영을 이용한 분획혈류예비력과 심근관류를 분석하여 관상동맥 질환의 혈역학적 유의성을 확인하는 기능적 평가를 통해 그 한계를 극복할 수 있다. 최근에는 이를 보다 객관적이고 재현 가능하도록 인공지능을 접목하는 연구들이 활발히 진행되고 있다. 본 종설에서는 심장 전산화단층촬영의 기능적 영상화 기법들에 대해 알아보고자 한다.

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Lesion-Specific Ischemia With Noninvasive Computed Tomographic Angiography

Cited by 6 publications

References 16 publications

Computed tomographic evaluation of myocardial ischemia

Computed tomographic evaluation of myocardial ischemia

The Changing Paradigm for Assessment of Ischemic Coronary Artery Disease

Beyond Coronary CT Angiography: CT Fractional Flow Reserve and Perfusion

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