Quantification of myocardial blood flow by adenosine-stress CT perfusion imaging in pigs during various degrees of stenosis correlates well with coronary artery blood flow and fractional flow reserve

Rossi, Alexia; Uitterdijk, André; Dijkshoorn, Marcel L.; Klotz, Ernst; Dharampal, Anoeshka S.; Straten, Marcel van; Giessen, Wim J. van der; Mollet, Nico R.; Geuns, Robert‐Jan van; Krestin, Gabriël P.; Duncker, Dirk J.; Feyter, Pim J. de; Merkus, Daphne

doi:10.1093/ehjci/jes150

Cited by 64 publications

(52 citation statements)

References 32 publications

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“…[30][31][32][33][34][35] The addition of stress myocardial CT perfusion imaging to the standard CTCA can provide complementary anatomic and functional information in a single examination. However, CT perfusion imaging involves increased patient radiation exposure, increased contrast volume, and potential patient's discomfort related to the administration of a pharmacological stress agent.…”

Section: Clinical Implications and Future Directionsmentioning

confidence: 99%

Quantitative Computed Tomographic Coronary Angiography

Rossi

Papadopoulou

Pugliese

et al. 2014

Circ: Cardiovascular Imaging

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Background-Coronary lesions with a diameter narrowing ≥50% on visual computed tomographic coronary angiography (CTCA) are generally considered for referral to invasive coronary angiography. However, similar to invasive coronary angiography, visual CTCA is often inaccurate in detecting functionally significant coronary lesions. We sought to compare the diagnostic performance of quantitative CTCA with visual CTCA for the detection of functionally significant coronary lesions using fractional flow reserve (FFR) as the reference standard. Methods and Results-CTCA and FFR measurements were obtained in 99 symptomatic patients. In total, 144 coronary lesions detected on CTCA were visually graded for stenosis severity. Quantitative CTCA measurements included lesion length, minimal area diameter, % area stenosis, minimal lumen diameter, % diameter stenosis, and plaque burden [(vessel area−lumen area)/vessel area×100]. Optimal cutoff values of CTCA-derived parameters were determined, and their diagnostic accuracy for the detection of flow-limiting coronary lesions (FFR ≤0.80) was compared with visual CTCA. FFR was ≤0.80 in 54 of 144 (38%) coronary lesions. Optimal cutoff values to predict flow-limiting coronary lesion were 10 mm for lesion length, 1.8 mm 2 for minimal area diameter, 73% for % area stenosis, 1.5 mm for minimal lumen diameter, 48% for % diameter stenosis, and 76% for plaque burden. No significant difference in sensitivity was found between visual CTCA and quantitative CTCA parameters (P>0.05). The specificity of visual CTCA (42%; 95% confidence interval [CI], 31%-54%) was lower than that of minimal area diameter (68%; 95% CI, 57%-77%; P=0.001), % area stenosis (76%; 95% CI, 65%-84%; P<0.001), minimal lumen diameter (67%; 95% CI, 55%-76%; P=0.001), % diameter stenosis (72%; 95% CI, 62%-80%; P<0.001), and plaque burden (63%; 95% CI, 52%-73%; P=0.004). The specificity of lesion length was comparable with that of visual CTCA. Conclusions-Quantitative CTCA improves the prediction of functionally significant coronary lesions compared with visual CTCA assessment but remains insufficient. Functional assessment is still required in lesions of moderate stenosis to accurately detect impaired FFR. (Circ Cardiovasc Imaging. 2014;7:43-51.)

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Section: Clinical Implications and Future Directionsmentioning

confidence: 99%

Quantitative Computed Tomographic Coronary Angiography

Rossi

Papadopoulou

Pugliese

et al. 2014

Circ: Cardiovascular Imaging

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“…However, these findings were based on a study population with severe coronary artery stenosis (79±15%), which may have affected their results as shown in Figure 5. [19][20][21] Moreover, their results might have been affected by the use of a narrow-detector CT, which provided heterogeneous dynamic CTP data with temporal and spatial gaps. 12, 20 In the present study, dynamic CTP scanning was performed with a high sampling rate using a wide-detector CT, which yielded whole-heart dynamic CTP data without temporal or spatial gaps.…”

Section: Discussionmentioning

confidence: 99%

“…[19][20][21] Moreover, their results might have been affected by the use of a narrow-detector CT, which provided heterogeneous dynamic CTP data with temporal and spatial gaps. 12, 20 In the present study, dynamic CTP scanning was performed with a high sampling rate using a wide-detector CT, which yielded whole-heart dynamic CTP data without temporal or spatial gaps. 13 We consider the CTP data obtained in the present study as better for evaluating the optimal scan time of single-phase CTP for detecting myocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

Optimal Scan Time for Single-Phase Myocardial Computed Tomography Perfusion to Detect Myocardial Ischemia　– Derivation Cohort From Dynamic Myocardial Computed Tomography Perfusion –

Tanabe

Kurata

Uetani

et al. 2016

Circ J

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“…109,110 Diverse combinations of hybrid imaging of myocardial perfusion (CT + SPECT, CT + PET and CT + CMR) are gaining increasing interest because they provide both anatomic and functional information, improving the overall performance of the diagnostic test.…”

Section: Hybrid Devices Computed Tomography Nuclear Imagementioning

confidence: 99%

Novel Imaging Techniques for Heart Failure

Melero-Ferrer

López‐Vilella

Morillas-Climent

et al. 2016

Cardiac Failure Review

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Heart failure (HF) is an epidemic with an increasing prevalence and an absolute mortality rate of approximately 50 % within 5 years of diagnosis. Imaging plays a main role in HF diagnosis, assessment of aetiology and treatment guidance. This article reviews current HF applications for all the available non-invasive imaging modalities: echocardiography, cardiovascular magnetic resonance (CMR), nuclear imaging-positron emission tomography (PET) and single-photon emission computed tomography (SPECT) and computed tomography (CT). Echocardiography, with its recent developments, such as 3D echo, is the main imaging test used in the evaluation of HF patients, given its availability and reliability in assessing cardiac structure and function. CMR allows the characterisation of myocardial tissue, in addition to providing information on the structure and cardiac function, so it is a great help in the determination of HF aetiology and may predict patient outcomes. Nuclear imaging can detect ischaemia and viability and can obtain additional prognostic data. Cardiac CT is EchocardiographyAlthough echocardiography is a relatively 'ancient' technique, its versatility makes it unique in the provision of volumes, function, haemodynamics or valvular regurgitation. In addition, because of its availability, safety and low cost, echocardiography is the first and most widely used test for the diagnosis, selection of appropriate treatment and prognosis of HF.1 Echocardiography is also the most used imaging method in the reassessment of HF patients. It remains unclear when to repeat echocardiographic exams, but it is deemed appropriate at least in patients with worsening symptoms. Systolic FunctionGlobal left ventricular (LV) function is of paramount importance regarding therapeutic decisions. Visual estimation of ejection fraction (EF), the Teichholz and Simpson methods, have been widely validated. 2,3However, in 2D imaging, because of its operator-dependent nature, repeated testing has a high probability of producing variable volume and EF results.The apparition of 3D fully sampled matrix transthoracic echocardiography has enabled easier acquisition of images, 4 simplifying its routinary application. There have been many studies comparing 2D and 3D echocardiography (2DE and 3DE) and a 'reference' standard (generally CMR). A recent meta-analysis of all 3DE studies evaluating LV volumes and EF demonstrated that 3DE generally underestimated volumes, but not as significantly as 2DE. There was also less variability than 2D compared with CMR.5 Nonetheless, 3DE echocardiography may be challenging and not practical in patients with low image quality (e.g. critical patients), in whom 2DE measures are more realiable. 3DE is also a less standardised techique than 2DE, and because of this reason most laboratories use the more universally applicable 2DE measurements in clinical practice. Only recently, large analyses of LV parameters using 3DE in large cohorts of healthy individuals have been published to establish race, age and gender-specific ...

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Quantification of myocardial blood flow by adenosine-stress CT perfusion imaging in pigs during various degrees of stenosis correlates well with coronary artery blood flow and fractional flow reserve

Abstract: Adenosine stress DSCT myocardial perfusion imaging allows quantification of regional MBF under various degrees of CBF reduction.

Cited by 64 publications

References 32 publications

Quantitative Computed Tomographic Coronary Angiography

Quantitative Computed Tomographic Coronary Angiography

Optimal Scan Time for Single-Phase Myocardial Computed Tomography Perfusion to Detect Myocardial Ischemia　– Derivation Cohort From Dynamic Myocardial Computed Tomography Perfusion –

Novel Imaging Techniques for Heart Failure

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Quantification of myocardial blood flow by adenosine-stress CT perfusion imaging in pigs during various degrees of stenosis correlates well with coronary artery blood flow and fractional flow reserve

Abstract: Adenosine stress DSCT myocardial perfusion imaging allows quantification of regional MBF under various degrees of CBF reduction.

Cited by 64 publications

References 32 publications

Quantitative Computed Tomographic Coronary Angiography

Quantitative Computed Tomographic Coronary Angiography

Optimal Scan Time for Single-Phase Myocardial Computed Tomography Perfusion to Detect Myocardial Ischemia – Derivation Cohort From Dynamic Myocardial Computed Tomography Perfusion –

Novel Imaging Techniques for Heart Failure

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Optimal Scan Time for Single-Phase Myocardial Computed Tomography Perfusion to Detect Myocardial Ischemia　– Derivation Cohort From Dynamic Myocardial Computed Tomography Perfusion –