Diagnostic accuracy of simultaneous evaluation of coronary arteries and myocardial perfusion with single stress cardiac computed tomography acquisition compared to invasive coronary angiography plus invasive fractional flow reserve

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Abstract

Background: Coronary computed tomography angiography (cCTA) has limited diagnostic accuracy in patients with intermediate to high pre-test likelihood of coronary artery disease (CAD) that may have large amounts of coronary calcium. Stress computed tomography myocardial perfusion (CTP) has emerged as a valuable strategy, combining anatomical and functional assessment of CAD. Purpose of the study is to evaluate the diagnostic accuracy of combining coronary artery imaging and myocardial perfusion in a single stress dataset versus invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as reference standard. Methods: One-hundred-thirty consecutive symptomatic patients (age: 65 ± 9 years; men: 70%) scheduled for clinically indicated ICA plus invasive FFR were prospectively enrolled. cCTA + CTP were simultaneously evaluated in a single stress-dataset by blinded readers and compared to ICA and invasive FFR findings. Results: CTP was successfully performed in all patients. The most common artifacts observed in the stress dataset for coronary artery imaging were blooming effect and motion effect related. Overall evaluability of coronary arteries by using cCTA stress dataset was 93%. In a vessel and patient-based model, stress cCTA + stress CTP showed sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 93%, 94%, 97%, 85%, 94%, and 98%, 86%, 98%, 85%, 92%, respectively. The overall effective dose (ED) of stress protocol acquisition alone was 2.5 ± 1.1 mSv. Conclusions: Simultaneous evaluation of coronary arteries and myocardial perfusion with single stress acquisition is feasible and it has diagnostic accuracy and low ED to identify functionally significant stenosis in patients with intermediate to high risk for CAD.

Original languageEnglish
Pages (from-to)263-268
Number of pages6
JournalInternational Journal of Cardiology
Volume273
DOIs
Publication statusPublished - Dec 15 2018

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Coronary Angiography
Coronary Vessels
Perfusion
Tomography
Coronary Artery Disease
Myocardial Perfusion Imaging
Artifacts
Pathologic Constriction
Calcium
Sensitivity and Specificity
Datasets
Computed Tomography Angiography

Keywords

  • Computed tomography
  • Coronary artery disease
  • Myocardial perfusion
  • Radiation exposure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{0b99489454d8497eaf1ab1283119dbbe,
title = "Diagnostic accuracy of simultaneous evaluation of coronary arteries and myocardial perfusion with single stress cardiac computed tomography acquisition compared to invasive coronary angiography plus invasive fractional flow reserve",
abstract = "Background: Coronary computed tomography angiography (cCTA) has limited diagnostic accuracy in patients with intermediate to high pre-test likelihood of coronary artery disease (CAD) that may have large amounts of coronary calcium. Stress computed tomography myocardial perfusion (CTP) has emerged as a valuable strategy, combining anatomical and functional assessment of CAD. Purpose of the study is to evaluate the diagnostic accuracy of combining coronary artery imaging and myocardial perfusion in a single stress dataset versus invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as reference standard. Methods: One-hundred-thirty consecutive symptomatic patients (age: 65 ± 9 years; men: 70{\%}) scheduled for clinically indicated ICA plus invasive FFR were prospectively enrolled. cCTA + CTP were simultaneously evaluated in a single stress-dataset by blinded readers and compared to ICA and invasive FFR findings. Results: CTP was successfully performed in all patients. The most common artifacts observed in the stress dataset for coronary artery imaging were blooming effect and motion effect related. Overall evaluability of coronary arteries by using cCTA stress dataset was 93{\%}. In a vessel and patient-based model, stress cCTA + stress CTP showed sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 93{\%}, 94{\%}, 97{\%}, 85{\%}, 94{\%}, and 98{\%}, 86{\%}, 98{\%}, 85{\%}, 92{\%}, respectively. The overall effective dose (ED) of stress protocol acquisition alone was 2.5 ± 1.1 mSv. Conclusions: Simultaneous evaluation of coronary arteries and myocardial perfusion with single stress acquisition is feasible and it has diagnostic accuracy and low ED to identify functionally significant stenosis in patients with intermediate to high risk for CAD.",
keywords = "Computed tomography, Coronary artery disease, Myocardial perfusion, Radiation exposure",
author = "Gianluca Pontone and Andrea Baggiano and Daniele Andreini and Guaricci, {Andrea I.} and Marco Guglielmo and Giuseppe Muscogiuri and Laura Fusini and Margherita Soldi and {Del Torto}, Alberico and Saima Mushtaq and Edoardo Conte and Giuseppe Calligaris and {De Martini}, Stefano and Cristina Ferrari and Stefano Galli and Luca Grancini and Paolo Olivares and Paolo Ravagnani and Giovanni Teruzzi and Daniela Trabattoni and Franco Fabbiocchi and Piero Montorsi and Rabbat, {Mark G.} and Bartorelli, {Antonio L.} and Mauro Pepi",
year = "2018",
month = "12",
day = "15",
doi = "10.1016/j.ijcard.2018.09.065",
language = "English",
volume = "273",
pages = "263--268",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Diagnostic accuracy of simultaneous evaluation of coronary arteries and myocardial perfusion with single stress cardiac computed tomography acquisition compared to invasive coronary angiography plus invasive fractional flow reserve

AU - Pontone, Gianluca

AU - Baggiano, Andrea

AU - Andreini, Daniele

AU - Guaricci, Andrea I.

AU - Guglielmo, Marco

AU - Muscogiuri, Giuseppe

AU - Fusini, Laura

AU - Soldi, Margherita

AU - Del Torto, Alberico

AU - Mushtaq, Saima

AU - Conte, Edoardo

AU - Calligaris, Giuseppe

AU - De Martini, Stefano

AU - Ferrari, Cristina

AU - Galli, Stefano

AU - Grancini, Luca

AU - Olivares, Paolo

AU - Ravagnani, Paolo

AU - Teruzzi, Giovanni

AU - Trabattoni, Daniela

AU - Fabbiocchi, Franco

AU - Montorsi, Piero

AU - Rabbat, Mark G.

AU - Bartorelli, Antonio L.

AU - Pepi, Mauro

PY - 2018/12/15

Y1 - 2018/12/15

N2 - Background: Coronary computed tomography angiography (cCTA) has limited diagnostic accuracy in patients with intermediate to high pre-test likelihood of coronary artery disease (CAD) that may have large amounts of coronary calcium. Stress computed tomography myocardial perfusion (CTP) has emerged as a valuable strategy, combining anatomical and functional assessment of CAD. Purpose of the study is to evaluate the diagnostic accuracy of combining coronary artery imaging and myocardial perfusion in a single stress dataset versus invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as reference standard. Methods: One-hundred-thirty consecutive symptomatic patients (age: 65 ± 9 years; men: 70%) scheduled for clinically indicated ICA plus invasive FFR were prospectively enrolled. cCTA + CTP were simultaneously evaluated in a single stress-dataset by blinded readers and compared to ICA and invasive FFR findings. Results: CTP was successfully performed in all patients. The most common artifacts observed in the stress dataset for coronary artery imaging were blooming effect and motion effect related. Overall evaluability of coronary arteries by using cCTA stress dataset was 93%. In a vessel and patient-based model, stress cCTA + stress CTP showed sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 93%, 94%, 97%, 85%, 94%, and 98%, 86%, 98%, 85%, 92%, respectively. The overall effective dose (ED) of stress protocol acquisition alone was 2.5 ± 1.1 mSv. Conclusions: Simultaneous evaluation of coronary arteries and myocardial perfusion with single stress acquisition is feasible and it has diagnostic accuracy and low ED to identify functionally significant stenosis in patients with intermediate to high risk for CAD.

AB - Background: Coronary computed tomography angiography (cCTA) has limited diagnostic accuracy in patients with intermediate to high pre-test likelihood of coronary artery disease (CAD) that may have large amounts of coronary calcium. Stress computed tomography myocardial perfusion (CTP) has emerged as a valuable strategy, combining anatomical and functional assessment of CAD. Purpose of the study is to evaluate the diagnostic accuracy of combining coronary artery imaging and myocardial perfusion in a single stress dataset versus invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as reference standard. Methods: One-hundred-thirty consecutive symptomatic patients (age: 65 ± 9 years; men: 70%) scheduled for clinically indicated ICA plus invasive FFR were prospectively enrolled. cCTA + CTP were simultaneously evaluated in a single stress-dataset by blinded readers and compared to ICA and invasive FFR findings. Results: CTP was successfully performed in all patients. The most common artifacts observed in the stress dataset for coronary artery imaging were blooming effect and motion effect related. Overall evaluability of coronary arteries by using cCTA stress dataset was 93%. In a vessel and patient-based model, stress cCTA + stress CTP showed sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 93%, 94%, 97%, 85%, 94%, and 98%, 86%, 98%, 85%, 92%, respectively. The overall effective dose (ED) of stress protocol acquisition alone was 2.5 ± 1.1 mSv. Conclusions: Simultaneous evaluation of coronary arteries and myocardial perfusion with single stress acquisition is feasible and it has diagnostic accuracy and low ED to identify functionally significant stenosis in patients with intermediate to high risk for CAD.

KW - Computed tomography

KW - Coronary artery disease

KW - Myocardial perfusion

KW - Radiation exposure

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U2 - 10.1016/j.ijcard.2018.09.065

DO - 10.1016/j.ijcard.2018.09.065

M3 - Article

C2 - 30268383

AN - SCOPUS:85053920350

VL - 273

SP - 263

EP - 268

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -