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
Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
J Cardiovasc Comput Tomogr. 2017 Jan-Feb;11(1):16-24. doi: 10.1016/j.jcct.2016.12.003. Epub 2016 Dec 28.
There is no published data on the prognostic value of global myocardial perfusion values at stress dynamic CT myocardial perfusion imaging (CTMPI).
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 (K). 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.
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 K were not independent predictors of MACE.
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.
关于负荷动态CT心肌灌注成像（CTMPI）时整体心肌灌注值的预后价值，尚无公开数据。
评估了来自6个中心的144例接受冠状动脉CT血管造影（冠状动脉CTA）和CTMPI的患者的数据。冠状动脉CTA检查在静息状态下进行；CTMPI在血管扩张剂负荷下进行。对冠状动脉CTA数据按血管逐一评估冠状动脉狭窄（管腔狭窄≥50%）情况。在整个左心室心肌上设置感兴趣区，以获取整体心肌血流量（MBF）、心肌血容量（MBV）和容积转运常数（K）。随访时间为6/12/18个月。主要不良心脏事件（MACE，定义为心源性死亡、非致命性心肌梗死、需住院治疗的不稳定型心绞痛和血运重建）作为终点。
40例患者发生了MACE（非致命性心肌梗死1例，不稳定型心绞痛13例，经皮冠状动脉介入治疗[PCI]23例，冠状动脉旁路移植术[CABG]3例）。整体MBF<121 mL/100 mL/min的患者发生MACE的风险增加（风险比[HR]2.07，95%置信区间[CI]：1.12 - 3.84，p = 0.02）。在调整年龄、性别和临床危险因素后，这种关联仍然显著（HR 2.17，95%CI：1.16 - 4.06，p = 0.02），在进一步调整冠状动脉CTA时存在≥50%狭窄情况后（HR 2.18，95%CI：1.16 - 4.10，p = 0.02）以及排除早期（<6个月）血运重建后（HR 2.34，95%CI：1.01 - 5.43，p = 0.0486）亦是如此。整体MBV和K不是MACE的独立预测因素。
负荷动态CTMPI时左心室MBF的整体定量对于未来MACE可能具有超过临床危险因素和冠状动脉CTA狭窄评估的增量预测价值。
