Meinel Felix G, Pugliese Francesca, Schoepf U Joseph, Ebersberger Ullrich, Wichmann Julian L, Lo Gladys G, Choe Yeon Hyeon, Wang Yining, Segreto Sabrina, Bamberg Fabian, De Cecco Carlo N
1 Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425.
2 Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
AJR Am J Roentgenol. 2017 Apr;208(4):761-769. doi: 10.2214/AJR.16.16186. Epub 2017 Feb 8.
The purpose of this study was to determine the prognostic value of myocardial perfusion CT for major adverse cardiac events (MACE).
Data from six centers in Asia, Europe, and North America on 144 patients with known or suspected coronary artery disease who had undergone coronary CT angiography (CCTA) and dynamic myocardial perfusion CT with a dual-source CT system were analyzed. CCTA studies were acquired at rest. Dynamic myocardial perfusion CT was performed under vasodilator stress. CCTA data were evaluated for the presence of coronary artery stenosis (≥ 50% luminal narrowing) on a per-vessel basis. Myocardial perfusion CT data were qualitatively evaluated for perfusion defects in each vessel territory. Patient follow-up was performed 6, 12, and 18 months after imaging. The prognostic value of CT findings was assessed with Kaplan-Meier statistics and the multivariate Cox proportional hazards regression model.
According to the CCTA findings, 62 of 144 patients (43.1%) had at least one 50% or greater stenosis. According to the myocardial perfusion CT findings, 51 patients (35.4%) had one or more perfusion defects. Patients with at least one perfusion defect at myocardial perfusion CT were at increased risk of MACE (hazard ratio, 2.50; 95% CI, 1.34-4.65; p = 0.0040). This association remained significant after adjustment for age, sex, and clinical risk factors (hazard ratio, 2.41; 95% CI, 1.28-4.51; p = 0.0064) and after further adjustment for CCTA findings (hazard ratio, 2.03; 95% CI, 1.04-3.97; p = 0.0390). The number of territories with perfusion defects was strongly predictive of MACE with adjusted hazard ratios of 1.41, 3.44, and 4.76 for one, two, and three affected territories.
In assessment for future MACE, myocardial perfusion CT has incremental predictive value over clinical risk factors and detection of coronary artery stenosis with CCTA.
本研究旨在确定心肌灌注CT对主要不良心脏事件（MACE）的预后价值。
分析了来自亚洲、欧洲和北美的六个中心的144例已知或疑似冠状动脉疾病患者的数据，这些患者均接受了冠状动脉CT血管造影（CCTA）和使用双源CT系统的动态心肌灌注CT检查。CCTA检查在静息状态下进行。动态心肌灌注CT在血管扩张剂负荷下进行。对CCTA数据按血管逐一评估冠状动脉狭窄（管腔狭窄≥50%）的存在情况。对心肌灌注CT数据进行定性评估，以确定每个血管区域的灌注缺损情况。在成像后6、12和18个月对患者进行随访。采用Kaplan-Meier统计法和多变量Cox比例风险回归模型评估CT检查结果的预后价值。
根据CCTA检查结果，144例患者中有62例（43.1%）至少有一处50%或以上的狭窄。根据心肌灌注CT检查结果，51例患者（35.4%）有一处或多处灌注缺损。心肌灌注CT检查至少有一处灌注缺损的患者发生MACE的风险增加（风险比，2.50；95%CI，1.34-4.65；p = 0.0040）。在对年龄、性别和临床风险因素进行校正后（风险比，2.41；95%CI，1.28-4.51；p = 0.0064）以及在对CCTA检查结果进行进一步校正后（风险比，2.03；95%CI，1.04-3.97；p = 0.0390），这种关联仍然显著。灌注缺损区域的数量对MACE具有很强的预测性，一处、两处和三处受影响区域的校正风险比分别为1.41、3.44和4.76。
在评估未来发生MACE的风险时，心肌灌注CT相对于临床风险因素以及通过CCTA检测冠状动脉狭窄具有额外的预测价值。
