Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, Milan, Italy.
Department of Cardiovascular Sciences and Community Health, University of Milan, Via C. Parea 4, Milan, Italy.
Eur Heart J Cardiovasc Imaging. 2018 Nov 1;19(11):1244-1252. doi: 10.1093/ehjci/jey111.
To compare the diagnostic accuracy of stress computed tomography myocardial perfusion (CTP) for the detection of significant coronary artery disease with visual approach vs. quantitative analysis with transmural perfusion ratio (TPR) in consecutive symptomatic patients scheduled for invasive coronary angiography (ICA) plus invasive fractional flow reserve (FFR).
Eighty-eight consecutive symptomatic patients underwent rest coronary computed tomography angiography (cCTA) followed by static stress-CTP. Diagnostic accuracy of cCTA + stress-CTP with visual evaluation and with TPR measurement was calculated and compared with ICA and invasive FFR. Addition of stress-CTP with qualitative evaluation to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy at a vessel and patient level of 92%, 92%, 97%, 82%, 92% and 98%, 80%, 97%, 82%, 89%, respectively indicating a significant improvement of specificity, positive predictive value, and accuracy values vs. rest-cCTA in both models. Similarly, addition of stress-CTP with TPR evaluation to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy at a vessel and patient level of 84%, 90%, 93%, 76%, 88% and 91%, 71%, 89%, 75%, 81%, respectively indicating a significant improvement of specificity, positive predictive value values vs. rest-cCTA only in a vessel-based model and of positive predictive value in a patient-based model. When cCTA + stress-CTP with qualitative evaluation was compared with cCTA + stress-CTP with TPR estimation, no differences were found in terms of diagnostic performance.
The addition of stress-CTP with visual evaluation to cCTA imaging has similar diagnostic performance when compared with the quantitative analysis of myocardial perfusion based on TPR measurement.
比较静息冠状动脉计算机断层血管造影术（cCTA）联合应激 CT 心肌灌注成像（CTP）的视觉评估与透壁灌注比（TPR）定量分析对拟行有创冠状动脉造影术（ICA）联合有创血流储备分数（FFR）的连续症状患者中显著冠状动脉疾病的诊断准确性。
88 例连续症状患者行静息 cCTA 后行静态应激 CTP。计算并比较了 cCTA+应激 CTP 视觉评估和 TPR 测量的诊断准确性，并与 ICA 和有创 FFR 进行比较。在静息 cCTA 基础上增加定性评估的应激 CTP，在血管和患者水平的敏感性、特异性、阴性和阳性预测值及准确性分别为 92%、92%、97%、82%、92%和 80%、97%、82%、89%，表明两种模型的特异性、阳性预测值和准确性均显著提高。同样，在静息 cCTA 基础上增加 TPR 评估的应激 CTP，在血管和患者水平的敏感性、特异性、阴性和阳性预测值及准确性分别为 84%、90%、93%、76%、88%和 91%、71%、89%、75%、81%，表明仅在血管模型中特异性和阳性预测值有所提高，而在患者模型中仅提高了阳性预测值。当将定性评估的 cCTA+应激 CTP 与 TPR 估计的 cCTA+应激 CTP 进行比较时，在诊断性能方面没有差异。
在静息 cCTA 成像基础上增加视觉评估的应激 CTP 与基于 TPR 测量的心肌灌注定量分析具有相似的诊断性能。
