在疑似冠心病的中高危症状患者中，采用全心脏覆盖 CT 扫描仪进行应激计算机断层扫描心肌灌注的增量诊断价值。
Incremental Diagnostic Value of Stress Computed Tomography Myocardial Perfusion With Whole-Heart Coverage CT Scanner in Intermediate- to High-Risk Symptomatic Patients Suspected of Coronary Artery Disease.
机构信息
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy.
出版信息
JACC Cardiovasc Imaging. 2019 Feb;12(2):338-349. doi: 10.1016/j.jcmg.2017.10.025. Epub 2018 Feb 14.
OBJECTIVES
The goal of this study was to evaluate the diagnostic accuracy of stress computed tomography myocardial perfusion (CTP) for the detection of functionally significant coronary artery disease (CAD) by using invasive coronary angiography (ICA) plus invasive fractional flow reserve (FFR) as the reference standard in consecutive intermediate- to high-risk symptomatic patients.
BACKGROUND
Stress CTP recently emerged as a potential strategy to combine the anatomic and functional evaluation of CAD in a single scan.
METHODS
A total of 100 consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest coronary computed tomography angiography (CTA) followed by stress static CTP with a whole-heart coverage CT scanner (Revolution CT, GE Healthcare, Milwaukee, Wisconsin). Diagnostic accuracy and overall effective dose were assessed and compared versus those of ICA and invasive FFR.
RESULTS
The prevalence of obstructive CAD and functionally significant CAD were 69% and 44%, respectively. Coronary CTA alone demonstrated a per-vessel and per-patient sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 98%, 76%, 99%, 63%, and 83% and of 98%, 54%, 96%, 68%, and 76%, respectively. Combining coronary CTA with stress CTP, per-vessel and per-patient sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 91%, 94%, 96%, 86%, and 93% and 98%, 83%, 98%, 86%, and 91%, with a significant improvement in specificity, positive predictive value, and accuracy in both models. The mean effective dose for coronary CTA and stress CTP were 2.8 ± 1.4 mSv and 2.5 ± 1.1 mSv.
CONCLUSIONS
The inclusion of stress CTP for the evaluation of patients with an intermediate to high risk for CAD is feasible and improved the diagnostic performance of coronary CTA for detecting functionally significant CAD.
目的
本研究旨在评估应激计算机断层心肌灌注（CTP）检测中高危症状性患者功能性显著冠状动脉疾病（CAD）的诊断准确性，以冠状动脉造影（ICA）加有创血流储备分数（FFR）为参考标准。
背景
应激 CTP 最近作为一种潜在策略出现，可在单次扫描中结合 CAD 的解剖和功能评估。
方法
前瞻性纳入 100 例拟行 ICA 的连续症状性患者。所有患者均行静息冠状动脉 CT 血管造影（CTA），然后使用全心脏覆盖 CT 扫描仪（GE Healthcare，威斯康星州密尔沃基市的 Revolution CT）进行应激静态 CTP。评估并比较诊断准确性和总有效剂量与 ICA 和有创 FFR 的比较。
结果
阻塞性 CAD 和功能性显著 CAD 的患病率分别为 69%和 44%。单独的冠状动脉 CTA 显示每支血管和每位患者的敏感性、特异性、阴性预测值、阳性预测值和准确性分别为 98%、76%、99%、63%和 83%和 98%、54%、96%、68%和 76%。将冠状动脉 CTA 与应激 CTP 相结合，每支血管和每位患者的敏感性、特异性、阴性预测值、阳性预测值和准确性分别为 91%、94%、96%、86%和 93%和 98%、83%、98%、86%和 91%，两种模型的特异性、阳性预测值和准确性均有显著提高。冠状动脉 CTA 和应激 CTP 的平均有效剂量分别为 2.8±1.4 mSv 和 2.5±1.1 mSv。
结论
在评估中高危 CAD 患者时，加入应激 CTP 是可行的，并且提高了冠状动脉 CTA 检测功能性显著 CAD 的诊断性能。
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