Qualitative and Quantitative Assessment of Adenosine Triphosphate Stress Whole-Heart Dynamic Myocardial Perfusion Imaging Using 256-Slice Computed Tomography

Kurata, Akira; Kawaguchi, Naoto; Kido, Teruhiko; Inoue, Kentaro; Suzuki, Jun; Ogimoto, Akiyoshi; Funada, Junichi; Higaki, Jitsuo; Miyagawa, Masao; Vembar, Mani; Mochizuki, Takashi

doi:10.1371/journal.pone.0083950

Cited by 31 publications

(24 citation statements)

References 32 publications

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“…Therefore, a comprehensive cardiac protocol involving the use of stress MR-MPI is helpful for diagnosing and managing CAD, even in patients with multivessel disease [19]. Stress MPI is essential for assessing the MAAR; therefore, many researchers have investigated stress-induced myocardial perfusion abnormalities using SPECT, MR, and CT [20] [21] [22].…”

Section: Discussionmentioning

confidence: 99%

Myocardial Segmentation of Area at Risk Based on Coronary Computed Tomography Angiography and Voronoi Diagram in Comparison with Magnetic Resonance Perfusion Imaging

Fukuyama¹,

Kurata²,

Tanabe³

et al. 2017

OJRad

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Purpose: To assess the clinical feasibility of automated segmentation of the myocardial area at risk (MAAR) using coronary computed tomography angiography (CT-MAAR), as compared to stress magnetic resonance myocardial perfusion imaging (MR-MPI). Materials and Methods: Thirty patients who underwent coronary computed tomography angiography (CTA) and stress MR-MPI were retrospectively evaluated. The myocardial territory of the left ventricle (LV) distal to coronary artery stenosis (≥50% or ≥70% stenosis on coronary CTA) was three-dimensionally quantified using a Voronoi diagram. The ratio of all stenosis-related territories to the LV volume was defined as CT-MAAR (%-LV volume). The proportion of segments with perfusion defects in stress MR-MPI to the total of 16 segments (range: 0% -100%; with a 6.3%-interval scale) was defined as the reference. Correlation was assessed using Spearman's test. The capability of CT-MAAR to predict the ischemic burden was assessed. Results: Stress MR-MPI depicted a median ischemic burden of 25.2% (range: 18.9% -44.1%) in 30 patients without myocardial infarction. When CTA stenosis criteria of ≥50% (n = 30) and ≥70% (n = 27) were applied to estimate CT-MAAR, the median CT-MAAR values were 48.2% (31.6% -64.3%) and 32.5% (23.7% -51.9%), respectively. The correlations between the CT-MAAR values and the MR-based ischemic burden were significant (0.73 and 0.97 for ≥50% and ≥70% stenosis, respectively). CT-MAAR predicted the MR-based ischemic burden within ±1 segment of %-LV (6.3%) in 40% (12/30) of patients with ≥50% stenosis, and in 81.5% (22/27) of How to cite this paper: Fukuyama, N., Kido, T., Kurata, A., Tanabe, Y., Kido, T., Yokoi, T., Ogawa, R., Nishiyama, H., Uetani, T. and Mochizuki, T. 10patients with ≥70% stenosis. Conclusions: Comprehensive assessment of resting coronary CTA combined with Voronoi diagram-based myocardial segmentation may help predict the myocardial ischemic burden in patients with severe coronary CTA stenosis.

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Section: Discussionmentioning

confidence: 99%

Myocardial Segmentation of Area at Risk Based on Coronary Computed Tomography Angiography and Voronoi Diagram in Comparison with Magnetic Resonance Perfusion Imaging

Fukuyama¹,

Kurata²,

Tanabe³

et al. 2017

OJRad

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“…Dynamic CTMP, and dual-energy CT that reduces beam-hardening artifacts, may improve the accuracy of CTMP. 64,65 Transluminal Attenuation Gradient/Corrected Contrast Opacification Resting flow impairment measured by differences in resting CTA contrast densities proximal and distal to a stenosis, with or without CCO to correct for the downstream decreases in attenuation inherent in studies not acquired with a single beat, has been evaluated in multiple studies with initially favorable results, despite an expected reduction in resting flow only with stenosis >90% (Figure 4). 54 Subsequent data have not been supportive of additive value.…”

Section: Ct Myocardial Perfusion Imagingmentioning

confidence: 99%

“…Greif et al 59 65 CTA indicates coronary computed tomographic angiography; CTP, computed tomographic stress myocardial perfusion imaging; FFR, fractional flow reserve; NA, not available; NPV, negative predictive value; PPV, positive predictive value; Pt, patient; and V, vessel.…”

Section: Per-vesselmentioning

confidence: 99%

Fractional Flow Reserve and Coronary Computed Tomographic Angiography

Hecht

Narula

Fearon

2016

Circulation Research

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Obstructive coronary artery disease (CAD) produces symptoms and increases the risk of adverse cardiac outcomes. However, determining whether a particular coronary stenosis is responsible for causing myocardial ischemia can be challenging, even with invasive coronary angiography (ICA). how should high-risk plaque be incorporated into treatment decisions? (7) how will CT-FFR influence other functional imaging test utilization, and what will be the effect on the practice of cardiology? (8) will a workstationbased CT-FFR be mandatory? Rapid progress to date suggests that CTA-based lesion-specific ischemia will be the gatekeeper to the cardiac catheterization laboratory and will transform the world of intervention.

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“…15 However, recently the physiological usage of CCTA as a physiological modality has been proposed. 16,17 Another issue of the stress tests in other countries would be an increasing use of pharmacological stress tests. According to the survey of Japanese circulation society in 2013, the numbers of exercise and vasodilator stress MPS were about 72,500 and 128,000, respectively.…”

Section: See Related Article Pp 1291-1300mentioning

confidence: 99%

Clinical value of high duke treadmill score with myocardial perfusion SPECT

Matsumoto

Hirayama

2016

Journal of Nuclear Cardiology

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Duke treadmill score (DTS) is well recognized as a simple prognostic score in patients with suspected coronary artery disease (CAD).1,2 It is positioned as a valid clinical tool when clinicians need to make a decision about the catheterization of patients with suspected CAD. It is calculated as follows, exercise duration (minutes) -(5 9 ST-segment deviation (millimeters) -(4 9 angina index (0 for no angina, 1 for angina, and 2 for exercise-limiting angina) and categorized as follows, low risk; \.5%/year, intermediate risk;.5% to 5%/year and high risk; [5%/year of cardiovascular events with a 4-year follow-up. Clinically, if patient achieved more than 10-minute duration of exercise without chest pain, 1 mm of ST depression on electrocardiogram (ECG) is permissible in terms of a conservative therapy. Shaw et al documented the incremental diagnostic value of DTS using ROC analysis to predict the presence of significant CAD (C75% stenosis) or severe CAD (3-vessel CAD or C75% left main disease).3 They showed the cardiac event rates for low-, moderate-, and high-risk grouping of DTS, annual cardiac death rates were .6%, 2%, and 7%, respectively, which were close to those in the original DTS. In that manuscript, they mentioned the limited sensitivity and specificity of the treadmill test for the detection of CAD may cause an increase of noninvasive stress imaging. 3,4 Previously, Hachamovitch et al also reported that stress myocardial perfusion single-photon emission computed tomography (MPS) adds an incremental prognostic value to DTS for the prediction of hard cardiac events. 5However, the expensive medical costs of stress imaging, which may add diagnostic accuracy to DTS, would be prohibitive. Therefore, the concordance and discordance between stress exercise test and noninvasive imaging should be discussed.A previous report showed that about 55% to 69% of patients with known or suspected CAD were classified as moderate risk by DTS. 3,6 Basically, the patients categorized as intermediate risk by DTS would be good candidates for stress MPS, the majority of the intermediate risk group may derive the maximum benefit for the differentiation of invasive catheter imaging in accordance with Bayes' theorem. 7,8 The higher sensitivity and specificity of stress MPS over that of the exercise test may reduce the unnecessary invasive imaging. 6The relationship between high DTS and stress MPS was evaluated by Shaikh et al in a small population (N = 13) in 2011. They showed that all the subjects with high DTS had high-risk MPS.9 They hypothesized that patients with high DTS can be referred for invasive coronary angiography without functional assessment. 9In this issue of the journal, Joao et al investigate the survival analysis in a great number of patients (N = 310) with both high DTS and exercise stress MPS. Nearly one-third of the patients (90/310) with high DTS showed normal MPS and low hard event rates. They found about 1.34%/year of cardiovascular death in the abnormal MPS group vs 0%/year of cardiovascular death in the norm...

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Qualitative and Quantitative Assessment of Adenosine Triphosphate Stress Whole-Heart Dynamic Myocardial Perfusion Imaging Using 256-Slice Computed Tomography

Cited by 31 publications

References 32 publications

Myocardial Segmentation of Area at Risk Based on Coronary Computed Tomography Angiography and Voronoi Diagram in Comparison with Magnetic Resonance Perfusion Imaging

Myocardial Segmentation of Area at Risk Based on Coronary Computed Tomography Angiography and Voronoi Diagram in Comparison with Magnetic Resonance Perfusion Imaging

Fractional Flow Reserve and Coronary Computed Tomographic Angiography

Clinical value of high duke treadmill score with myocardial perfusion SPECT

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