Nagy Ferenc T, Olajos Dorottya, Vattay Borbála, Borzsák Sarolta, Boussoussou Melinda, Deák Mónika, Vecsey-Nagy Milán, Sipos Barbara, Jermendy Ádám L, Tóth Gábor G, Nemes Balázs, Merkely Béla, Szili-Török Tamás, Ruzsa Zoltán, Szilveszter Bálint
Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary.
Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary.
J Cardiovasc Dev Dis. 2023 Oct 25;10(11):443. doi: 10.3390/jcdd10110443.
Chronic limb-threatening ischemia (CLTI) is associated with high rates of long-term cardiovascular mortality. Exercise stress testing to detect obstructive coronary artery disease (CAD) can be difficult in this subset of patients due to inability to undergo exercise testing, presence of balanced ischemia and severe coronary artery calcification (CAC).
To test the feasibility of regadenoson stress dynamic perfusion computed tomography (DPCT) in CLTI patients.
Between 2018 and 2023, coronary computed tomography angiography (CTA) and, in the case of a calcium score higher than 400, DPCT, were performed in 25 CLTI patients with a history of endovascular revascularization.
Of the 25 patients, 19 had a calcium score higher than 400, requiring DPCT image acquisition. Obstructive CAD could be ruled out in 10 of the 25 patients. Of the 15 CTA/DPCT+ patients, 13 proceeded to coronary angiography (CAG). Revascularization was necessary in all 13 patients. In these 13 patients, vessel-based sensitivity and specificity of coronary CTA/DPCT as compared to invasive evaluation was 75%, respectively. At follow-up (27 ± 21 months) there was no statistically significant difference in all-cause mortality between CTA/DPCT- positive and -negative patients ( = 0.065).
Despite a high prevalence of severe CAC, coronary CTA complemented by DPCT may be a feasible method to detect obstructive and functionally significant CAD in CLTI patients.
慢性肢体威胁性缺血（CLTI）与长期心血管死亡率高相关。由于无法进行运动测试、存在平衡缺血和严重冠状动脉钙化（CAC），在这类患者中检测阻塞性冠状动脉疾病（CAD）的运动应激测试可能具有挑战性。
测试雷加昔布应激动态灌注计算机断层扫描（DPCT）在CLTI患者中的可行性。
在2018年至2023年期间，对25例有血管内血运重建病史的CLTI患者进行了冠状动脉计算机断层扫描血管造影（CTA），对于钙评分高于400的患者进行了DPCT。
25例患者中，19例钙评分高于400，需要进行DPCT图像采集。25例患者中有10例可排除阻塞性CAD。在15例CTA/DPCT阳性患者中，13例进行了冠状动脉造影（CAG）。所有13例患者均需要血运重建。在这13例患者中，与侵入性评估相比，冠状动脉CTA/DPCT基于血管的敏感性和特异性分别为75%。在随访（27±21个月）时，CTA/DPCT阳性和阴性患者之间的全因死亡率无统计学显著差异（P = 0.065）。
尽管严重CAC的患病率很高，但冠状动脉CTA联合DPCT可能是检测CLTI患者阻塞性和功能上有意义的CAD的一种可行方法。
