计算机断层扫描灌注改善了女性冠状动脉计算机断层扫描血管造影的诊断能力：根据性别对CORE320试验（使用320排多探测器计算机断层扫描血管造影和心肌灌注进行冠状动脉评估）的分析
Computed Tomographic Perfusion Improves Diagnostic Power of Coronary Computed Tomographic Angiography in Women: Analysis of the CORE320 Trial (Coronary Artery Evaluation Using 320-Row Multidetector Computed Tomography Angiography and Myocardial Perfusion) According to Gender.
作者信息
Penagaluri Ashritha, Higgins Angela Y, Vavere Andrea L, Miller Julie M, Arbab-Zadeh Armin, Betoko Aisha, Steveson Chloe, Zimmermann Elke, Cox Christopher, Rochitte Carlos E, Dewey Marc, Kofoed Klaus F, Niinuma Hiroyuki, Di Carli Marcelo F, Lima João A C, Chen Marcus Y
机构信息
From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of Copenhagen, Denmark (K.F.K); St Luke's International Hospital, Tokyo, Japan (H.N.); and Brigham and Women's Hospital, Boston, MA (M.F.D.C.).
出版信息
Circ Cardiovasc Imaging. 2016 Nov;9(11). doi: 10.1161/CIRCIMAGING.116.005189.
BACKGROUND
Coronary computed tomographic angiography (CTA) and myocardial perfusion imaging (CTP) is a validated approach for detection and exclusion of flow-limiting coronary artery disease (CAD), but little data are available on gender-specific performance of these modalities. In this study, we aimed to evaluate the diagnostic accuracy of combined coronary CTA and CTP in detecting flow-limiting CAD in women compared with men.
METHODS AND RESULTS
Three hundred and eighty-one patients who underwent both CTA-CTP and single-photon emission computed tomography myocardial perfusion imaging preceding invasive coronary angiography as part of the CORE320 multicenter study (Coronary Artery Evaluation Using 320-row Multidetector Computed Tomography Angiography and Myocardial Perfusion) were included in this ancillary study. All 4 image modalities were analyzed in blinded, independent core laboratories. Prevalence of flow-limiting CAD defined by invasive coronary angiography equal to 50% or greater with an associated single-photon emission computed tomography myocardial perfusion imaging defect was 45% (114/252) and 23% (30/129) in males and females, respectively. Patient-based diagnostic accuracy defined by the area under the receiver operating curve for detecting flow-limiting CAD by CTA alone in females was 0.83 (0.75-0.89) and for CTA-CTP was 0.92 (0.86-0.97; P=0.003) compared with men where the area under the receiver operating curve for detecting flow-limiting CAD by CTA alone was 0.82 (0.77-0.87) and for CTA-CTP was 0.84 (0.80-0.89; P=0.29).
CONCLUSIONS
The combination of CTA-CTP was performed similarly in men and women for identifying flow-limiting coronary stenosis; however, in women, CTP had incremental value over CTA alone, which was not the case in men.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00934037.
背景
冠状动脉计算机断层血管造影（CTA）和心肌灌注成像（CTP）是检测和排除血流限制性冠状动脉疾病（CAD）的一种有效方法，但关于这些检查方法在不同性别中的表现的数据较少。在本研究中，我们旨在评估联合冠状动脉CTA和CTP检测女性与男性血流限制性CAD的诊断准确性。
方法与结果
作为CORE320多中心研究（使用320排多层螺旋CT血管造影和心肌灌注评估冠状动脉）的一部分，381例在有创冠状动脉造影之前接受了CTA-CTP和单光子发射计算机断层心肌灌注成像的患者被纳入这项辅助研究。所有4种影像检查方法均在盲法、独立的核心实验室进行分析。根据有创冠状动脉造影定义的血流限制性CAD患病率，即狭窄等于或大于50%且伴有单光子发射计算机断层心肌灌注成像缺损，男性为45%（114/252），女性为23%（30/129）。以患者为基础的诊断准确性，通过女性单独使用CTA检测血流限制性CAD的受试者操作特征曲线下面积为0.83（0.75-0.89），CTA-CTP为0.92（0.86-0.97；P=0.003），而男性单独使用CTA检测血流限制性CAD的受试者操作特征曲线下面积为0.82（0.77-0.87），CTA-CTP为0.84（0.80-0.89；P=0.29）。
结论
CTA-CTP联合检查在识别男性和女性血流限制性冠状动脉狭窄方面表现相似；然而，在女性中，CTP相对于单独使用CTA具有增量价值，而在男性中并非如此。
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