根据冠状动脉疾病的预测试概率和冠状动脉钙化严重程度分层，计算机断层扫描心肌灌注成像相对于冠状动脉造影的增量诊断准确性：CORE320研究。
Incremental diagnostic accuracy of computed tomography myocardial perfusion imaging over coronary angiography stratified by pre-test probability of coronary artery disease and severity of coronary artery calcification: The CORE320 study.
作者信息
Sharma Ravi K, Arbab-Zadeh Armin, Kishi Satoru, Chen Marcus Y, Magalhães Tiago A, George Richard T, Dewey Marc, Rybicki Frank J, Kofoed Klaus F, de Roos Albert, Tan Swee Yaw, Matheson Matthew, Vavere Andrea, Cox Christopher, Clouse Melvin E, Miller Julie M, Brinker Jeffery A, Arai Andrew E, Di Carli Marcelo F, Rochitte Carlos E, Lima Joao A C
机构信息
Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
出版信息
Int J Cardiol. 2015 Dec 15;201:570-7. doi: 10.1016/j.ijcard.2015.05.110. Epub 2015 May 19.
BACKGROUND
Myocardial CT perfusion (CTP) has been validated as an incremental diagnostic predictor over coronary computed tomography angiography (CTA) in assessing hemodynamically significant stenosis.
OBJECTIVES
To assess the diagnostic performance of CTA and CTP alone versus combined CTA-CTP stratified by Morise's pre-test probability and coronary artery calcium (CAC, Agatston) score.
METHODS
381 individuals (153 low/intermediate-risk for CAD, 83 high-risk, 145 known CAD) were further stratified based on CAC score cut-offs of 1-399 and ≥400. Area under the curve for receiver operating characteristics (AUC) was calculated to assess the diagnostic performance. Reference standards were QCA≥50% stenosis+corresponding SPECT summed stress score ≥1.
RESULTS
In both pre-test risk groups with an Agatston score of 1-399, AUCs of CTA-CTP were not significantly different than that from CTA alone. In the low/intermediate-risk group with CAC score 1-399, AUC for CTA-CTP (89) was higher than that for CTP (76, p=0.003) alone. In the same group with CAC score ≥400, AUCs were higher for CTA-CTP (97) than that for CTA (88, p=0.030) and CTP (83, p=0.033). In high risk/known CAD patients with CAC 1-399, diagnostic performance for CTA-CTP (77) was superior to CTP (71, p=0.037) alone. In the high risk/known CAD group with CAC score ≥400, AUCs for combined imaging were higher (86) than that for CTA (75, p<0.001) as well as CTP (78, p=0.020).
CONCLUSIONS
The incremental diagnostic accuracy of CTP over CTA persists in patients across severity spectra of pre-test probability of CAD and coronary artery calcification. In patients with severe coronary calcification (CAC score≥400), combined CTA-CTP has better diagnostic accuracy than CTA and CTP alone.
背景
心肌CT灌注成像（CTP）已被证实，在评估血流动力学显著狭窄方面，是一种优于冠状动脉CT血管造影（CTA）的增量诊断预测指标。
目的
根据Morise的预测试概率和冠状动脉钙化（CAC，阿加斯顿评分）分层，评估单独CTA和CTP以及联合CTA-CTP的诊断性能。
方法
381例个体（153例CAD低/中度风险、83例高风险、145例已知CAD）根据CAC评分截断值1-399和≥400进一步分层。计算受试者操作特征曲线下面积（AUC）以评估诊断性能。参考标准为定量冠状动脉造影（QCA）≥50%狭窄+相应的单光子发射计算机断层扫描（SPECT）总应力评分≥1。
结果
在阿加斯顿评分为1-399的两个预测试风险组中，CTA-CTP的AUC与单独CTA的AUC无显著差异。在CAC评分为1-399的低/中度风险组中，CTA-CTP的AUC（89）高于单独CTP的AUC（76，p=0.003）。在同一组中，CAC评分≥400时，CTA-CTP的AUC（97）高于CTA（88，p=0.030）和CTP（83，p=0.033）。在CAC为1-399的高风险/已知CAD患者中，CTA-CTP的诊断性能（77）优于单独CTP（71，p=0.037）。在CAC评分≥400的高风险/已知CAD组中，联合成像的AUC（86）高于CTA（75，p<0.001）和CTP（78，p=0.020）。
结论
在CAD预测试概率和冠状动脉钙化严重程度谱的患者中，CTP相对于CTA的增量诊断准确性仍然存在。在严重冠状动脉钙化（CAC评分≥400）的患者中，联合CTA-CTP比单独CTA和CTP具有更好的诊断准确性。
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