Journal of cardiovascular computed tomography · 2016
Global quantification of left ventricular myocardial perfusion at dynamic CT imaging: Prognostic value.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Meinel Felix G, Wichmann Julian L, Schoepf U Joseph, Pugliese Francesca, Ebersberger Ullrich, Lo Gladys G, Choe Yeon Hyeon, Wang Yining, Tesche Christian, Segreto Sabrina, Kunz Wolfgang G, Thierfelder Kolja M, Bamberg Fabian, De Cecco Carlo N
Аннотация
BACKGROUND: There is no published data on the prognostic value of global myocardial perfusion values at stress dynamic CT myocardial perfusion imaging (CTMPI).
METHODS: Data of 144 patients from 6 centers who had undergone coronary CT angiography (coronary CTA) and CTMPI were assessed. Coronary CTA studies were acquired at rest; CTMPI was performed under vasodilator stress. Coronary CTA data were evaluated for coronary artery stenosis (≥50% luminal narrowing) on a per-vessel basis. Volumes-of-interest were placed over the entire left ventricular myocardium to obtain global myocardial blood flow (MBF), myocardial blood volume (MBV), and volume transfer constant (Ktrans). Follow-up was obtained at 6/12/18 months. Major adverse cardiac events (MACE, defined as cardiac death, non-fatal myocardial infarction, unstable angina requiring hospitalization, and revascularization) served as the endpoint.
RESULTS: MACE occurred in 40 patients (nonfatal myocardial infarction, n = 1, unstable angina, n = 13, PCI, n = 23, and CABG, n = 3). Patients with global MBF of <121 mL/100 mL/min were at increased risk for MACE (HR 2.07, 95% confidence interval [CI]: 1.12-3.84, p = 0.02). This association remained significant after adjusting for age, gender, and clinical risk factors (HR 2.17, 95%CI: 1.16-4.06, p = 0.02), after further adjusting for presence of ≥50% stenosis at coronary CTA (HR 2.18, 95%CI: 1.16-4.10, p = 0.02) and when excluding early (<6 months) revascularizations (HR 2.34, 95%CI: 1.01-5.43, p = 0.0486). Global MBV and Ktrans were not independent predictors of MACE.
CONCLUSION: Global quantification of left ventricular MBF at stress dynamic CTMPI may have incremental predictive value for future MACE over clinical risk factors and assessment of stenosis at coronary CTA.
METHODS: Data of 144 patients from 6 centers who had undergone coronary CT angiography (coronary CTA) and CTMPI were assessed. Coronary CTA studies were acquired at rest; CTMPI was performed under vasodilator stress. Coronary CTA data were evaluated for coronary artery stenosis (≥50% luminal narrowing) on a per-vessel basis. Volumes-of-interest were placed over the entire left ventricular myocardium to obtain global myocardial blood flow (MBF), myocardial blood volume (MBV), and volume transfer constant (Ktrans). Follow-up was obtained at 6/12/18 months. Major adverse cardiac events (MACE, defined as cardiac death, non-fatal myocardial infarction, unstable angina requiring hospitalization, and revascularization) served as the endpoint.
RESULTS: MACE occurred in 40 patients (nonfatal myocardial infarction, n = 1, unstable angina, n = 13, PCI, n = 23, and CABG, n = 3). Patients with global MBF of <121 mL/100 mL/min were at increased risk for MACE (HR 2.07, 95% confidence interval [CI]: 1.12-3.84, p = 0.02). This association remained significant after adjusting for age, gender, and clinical risk factors (HR 2.17, 95%CI: 1.16-4.06, p = 0.02), after further adjusting for presence of ≥50% stenosis at coronary CTA (HR 2.18, 95%CI: 1.16-4.10, p = 0.02) and when excluding early (<6 months) revascularizations (HR 2.34, 95%CI: 1.01-5.43, p = 0.0486). Global MBV and Ktrans were not independent predictors of MACE.
CONCLUSION: Global quantification of left ventricular MBF at stress dynamic CTMPI may have incremental predictive value for future MACE over clinical risk factors and assessment of stenosis at coronary CTA.
Предметные рубрики MeSH
AgedAngina, UnstableAsiaComputed Tomography AngiographyCoronary AngiographyCoronary Artery DiseaseCoronary CirculationCoronary StenosisEuropeFemaleHospitalizationHumansKaplan-Meier EstimateMaleMiddle AgedMyocardial InfarctionMyocardial Perfusion ImagingMyocardial RevascularizationPredictive Value of TestsPrognosisProportional Hazards ModelsRegistriesRetrospective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexUnited States