Prognostic value of CT myocardial perfusion imaging and CT-derived fractional flow reserve for major adverse cardiac events in patients with coronary artery disease

Assen, Marly van; Cecco, Carlo N. De; Eid, Marwen; Doeberitz, Philipp von Knebel; Scarabello, Marco; Lavra, Francesco; Bauer, Maximilian J.; Mastrodicasa, Domenico; Duguay, Taylor M.; Zaki, Beatrice; Lo, Gladys; Choe, Yeon Hyeon; Wang, Y; Sahbaee, Pooyan; Tesche, Christian; Oudkerk, Matthijs; Vliegenthart, Rozemarijn; Schoepf, U. Joseph

doi:10.1016/j.jcct.2019.02.005

Cited by 49 publications

(27 citation statements)

References 43 publications

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“…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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Section: Current Evidence Of Ctpmentioning

confidence: 99%

Computed tomographic evaluation of myocardial ischemia

et al. 2020

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“…In comparison with CT-FFR, CTP has some advantages such as its accessibility, real-time stress myocardial perfusion imaging, instant analysis, and integrating assessment with coronary CTA. Moreover, CTP has a potential to have higher prognostic value for major adverse cardiac events [21].…”

Section: Discussionmentioning

confidence: 99%

Combined assessment of subtended myocardial volume and myocardial blood flow for diagnosis of obstructive coronary artery disease using cardiac computed tomography: A feasibility study

Tanabe

Kurata

Uetani

et al. 2020

Journal of Cardiology

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Background: This study aimed to evaluate the combined diagnostic performance of coronary artery stenosis-subtended myocardial volume (V sub ) and myocardial blood flow (MBFsub) on computed tomography (CT) for detecting obstructive coronary artery disease (CAD) assessed by invasive coronary angiography (ICA) and fractional flow reserve (FFR). Methods: Thirty-nine patients who underwent coronary CT angiography (CTA) and stress dynamic myocardial CT perfusion (CTP) prior to ICA were enrolled. Obstructive CAD was defined as severe (!70%) or moderate (30-69%) stenosis with FFR 0.8 on ICA. The V sub was semi-automatically calculated from coronary CTA data using Voronoi diagram-based myocardial segmentation. The standard CT-MBF based on the 17-segment model was calculated using dynamic stress CTP data and deconvolution analysis. The CT-MBFsub was automatically analyzed by integrating the CT-MBF and Voronoi diagram-based myocardial segmentation analyses. The diagnostic performance of combined CT-MBFsub and V sub assessment was determined using receiver operating characteristic analysis and compared with standard CT-MBF and CT-MBFsub. Results: Of 117 vessels in 39 patients, 72 vessels were suspected of significant stenosis on CTA and 33 vessels had obstructive CAD on ICA and FFR. The sensitivity and specificity for identifying obstructive CAD were 67% and 82% for standard CT-MBF, 70% and 77% for CT-MBFsub, and 85% and 82% for combined CT-MBFsub and V sub assessment. The area under the receiver operating characteristic curve of the combined CT-MBFsub and V sub assessment was significantly higher than those of standard CT-MBF and CT-MBFsub (0.89 vs. 0.75, 0.77; p < 0.05). Conclusions: The V sub may aid in increasing the diagnostic performance of CT-MBFsub for detecting obstructive CAD.

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“…Using dynamic CTP, a summed stress score based on MBF values proved to be prognostically relevant after adjusted for obstructive CAD on CTA with hazard ratio (HR) of 5.7 (CI: 1.9-16.9, P 5 0.002) [52]. Also, myocardial perfusion defect defined by low index-MBF (<0.88) calculated as a ratio between each segment and global MBF values was associated with MACE after adjusting for coronary CTA, CT-FFR findings, age, sex, and risk factors (HR: 10.1, CI: 2.1-48.8, P 5 0.004) [53]. Notably, dynamic CTP derived perfusion parameters had additive prognostic value beyond clinical risk factors and stenosis severity assessed by coronary CTA [54].…”

Section: Stable Anginamentioning

confidence: 91%

Myocardial perfusion imaging using computed tomography: Current status, clinical value and prognostic implications

Vattay

Boussoussou

Borzsák

et al. 2021

Imaging

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Combined anatomical and functional evaluation of coronary artery disease (CAD) using computed tomography (CT) has recently emerged as an accurate, robust and non-invasive tool for the evaluation of ischemic heart disease. Cardiac CT has become a one-stop-shop imaging modality that allows the simultaneous depiction, characterization and quantification of coronary atherosclerosis and the assessment of myocardial ischemia. Advancements in scanner technology (improvements in spatial and temporal resolution, dual-energy imaging, wide detector panels) and the implementation of iterative reconstruction algorithms enables the detection of myocardial ischemia in both qualitative and quantitative fashion using low-dose scanning protocols. The addition of CT perfusion (CTP) to standard coronary CT angiography is a reliable tool to improve diagnostic accuracy. CTP using static first-pass imaging enables qualitative assessment of the myocardial tissue, whereas dynamic perfusion imaging can also provide quantitative information on myocardial blood flow. Myocardial tissue assessment by CTP holds the potential to refine risk in stable chest pain or microvascular dysfunction. CTP can aid the detection of residual ischemia after coronary intervention. Comprehensive evaluation of CAD using CTP might therefore improve the selection of patients for aggressive secondary prevention therapy or coronary revascularization with high diagnostic certainty. In addition, prognostic information provided by perfusion CT imaging could improve patient outcomes by quantifying the ischemic burden of the left ventricle. The current review focuses on the clinical value of myocardial perfusion imaging by CT, current status of CTP imaging and the use of myocardial CTP in various patient populations for the diagnosis of ischemic heart disease.

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Prognostic value of CT myocardial perfusion imaging and CT-derived fractional flow reserve for major adverse cardiac events in patients with coronary artery disease

Cited by 49 publications

References 43 publications

Computed tomographic evaluation of myocardial ischemia

Computed tomographic evaluation of myocardial ischemia

Combined assessment of subtended myocardial volume and myocardial blood flow for diagnosis of obstructive coronary artery disease using cardiac computed tomography: A feasibility study

Myocardial perfusion imaging using computed tomography: Current status, clinical value and prognostic implications

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