Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, the Netherlands.
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Radiology, Emory University, Atlanta, Georgia, USA.
J Cardiovasc Comput Tomogr. 2019 May-Jun;13(3):26-33. doi: 10.1016/j.jcct.2019.02.005. Epub 2019 Feb 12.
The purpose of this study was to analyze the prognostic value of dynamic CT perfusion imaging (CTP) and CT derived fractional flow reserve (CT-FFR) for major adverse cardiac events (MACE).
81 patients from 4 institutions underwent coronary computed tomography angiography (CCTA) with dynamic CTP imaging and CT-FFR analysis. Patients were followed-up at 6, 12, and 18 months after imaging. MACE were defined as cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, or revascularization. CT-FFR was computed for each major coronary artery using an artificial intelligence-based application. CTP studies were analyzed per vessel territory using an index myocardial blood flow, the ratio between territory and global MBF. The prognostic value of CCTA, CT-FFR, and CTP was investigated with a univariate and multivariate Cox proportional hazards regression model.
243 vessels in 81 patients were interrogated by CCTA with CT-FFR and 243 vessel territories (1296 segments) were evaluated with dynamic CTP imaging. Of the 81 patients, 25 (31%) experienced MACE during follow-up. In univariate analysis, a positive index-MBF resulted in the largest risk for MACE (HR 11.4) compared to CCTA (HR 2.6) and CT-FFR (HR 4.6). In multivariate analysis, including clinical factors, CCTA, CT-FFR, and index-MBF, only index-MBF significantly contributed to the risk of MACE (HR 10.1), unlike CCTA (HR 1.2) and CT-FFR (HR 2.2).
Our study provides initial evidence that dynamic CTP alone has the highest prognostic value for MACE compared to CCTA and CT-FFR individually or a combination of the three, independent of clinical risk factors.
本研究旨在分析动态 CT 灌注成像（CTP）和 CT 衍生的血流储备分数（CT-FFR）对主要不良心脏事件（MACE）的预后价值。
来自 4 个机构的 81 名患者接受了冠状动脉计算机断层扫描血管造影（CCTA）检查，并进行了动态 CTP 成像和 CT-FFR 分析。患者在成像后 6、12 和 18 个月进行随访。MACE 定义为心脏死亡、非致死性心肌梗死、需要住院的不稳定型心绞痛或血运重建。使用基于人工智能的应用程序为每条主要冠状动脉计算 CT-FFR。使用区域与整体心肌血流量比作为指标心肌血流量对 CTP 研究进行血管区域分析。使用单变量和多变量 Cox 比例风险回归模型研究 CCTA、CT-FFR 和 CTP 的预后价值。
81 名患者的 243 条血管接受了 CCTA 检查和 CT-FFR 检查，243 个血管区域（1296 个节段）接受了动态 CTP 成像检查。在 81 名患者中，有 25 名（31%）在随访期间发生了 MACE。在单变量分析中，与 CCTA（HR 2.6）和 CT-FFR（HR 4.6）相比，正指数-MBF 导致 MACE 的风险最大（HR 11.4）。在多变量分析中，包括临床因素、CCTA、CT-FFR 和指数-MBF，只有指数-MBF 显著增加了 MACE 的风险（HR 10.1），而 CCTA（HR 1.2）和 CT-FFR（HR 2.2）则不然。
本研究初步证明，与 CCTA 和 CT-FFR 单独或三者联合相比，动态 CTP 单独对 MACE 的预后价值最高，独立于临床危险因素。
