支架置入患者中动态应力心肌CT灌注与有创生理学检查相比的诊断准确性：Advantage 2研究
Diagnostic Accuracy of Dynamic Stress Myocardial CT Perfusion Compared with Invasive Physiology in Patients with Stents: The Advantage 2 Study.
作者信息
Andreini Daniele, Mushtaq Saima, Trabattoni Daniela, Conte Edoardo, Sonck Jeroen, Lorusso Gerardo, Galli Stefano, Monizzi Giovanni, Belmonte Marta, Grancini Luca, Teruzzi Giovanni, Troiano Sarah, Gili Sebastiano, Montorsi Piero, Olivares Paolo, Mallia Vincenzo, Marchetti Davide, Schillaci Matteo, Gallinoro Emanuele, Paolisso Pasquale, Gigante Carlo, Melotti Eleonora, Baggiano Andrea, Mancini Maria Elisabetta, Annoni Andrea, Formenti Alberto, Sakai Koshiro, Mizukami Takuya, Pontone Gianluca, Zanotto Lorenza, Bartorelli Antonio L, Collet Carlos
机构信息
From the Centro Cardiologico Monzino, IRCCS, Via C. Belgioioso 173, Milan, Italy (D.A., S.M., D.T., E.C., G.L., S. Galli, G.M., L.G., G.T., S.T., S. Gili, P.M., P.O., V.M., D.M., M.S., C.G., E.M., A.B., M.E.M., A.A., A F., G.P., A.L.B.); Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy (D.A.); IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy (E.C., G.M., L.G., V.M., D.M., M.S., E.G., P.P., E.M., A.L.B.); Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (J.S., M.B., E.G., P.P., K.S., T.M., C.C.); Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (K.S., T.M.); Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy (G.P.); and Department of Radiology, Azienda Ospedaliera di Padova, Padua, Italy (L.Z.).
出版信息
Radiology. 2024 Dec;313(3):e232225. doi: 10.1148/radiol.232225.
Background The detection of in-stent restenosis (ISR) with coronary CT angiography (CCTA) is challenging, but CT perfusion (CTP) has demonstrated improved diagnostic accuracy over CCTA in patients with stents. However, there are limited data on the performance of dynamic CTP, which allows noninvasive adjudication of regional myocardial blood flow. Purpose To compare the diagnostic performance of regadenoson-stress dynamic CTP with that of CCTA, using fractional flow reserve (FFR) and the index of microvascular resistance (IMR) as reference standards for epicardial coronary circulation and coronary microcirculation, respectively. Materials and Methods Between January 2021 and June 2022, this prospective study enrolled patients with stents with indication for invasive coronary angiography due to suspicion of ISR or coronary artery disease progression. Participants underwent dynamic stress myocardial CTP and rest CTP plus CCTA. A wide coverage (z-axis coverage, 16 cm) and fast (gantry rotation time, 0.28 second) scanner was used. During invasive coronary angiography, FFR and IMR were obtained. The diagnostic rate (number of interpretable territories divided by number of evaluated territories) and accuracy of CCTA and CTP were evaluated in a territory-based analysis and compared with FFR and IMR (primary end points of the study). Results The study included 156 consecutive patients (136 men [87%]; mean age, 63.1 years ± 8.2 [SD]) with 504 stents. The diagnostic rate was higher for CTP than for CCTA (98.7% [789 of 799 territories] vs 95.6% [764 of 799 territories], < .001). With use of FFR as the reference standard, sensitivity, specificity, and diagnostic accuracy were higher for CTP than for CCTA (89.0%, 82.8%, and 84.7%, respectively, vs 60.0%, 61.9%, and 61.5%; < .001). With use of IMR as the reference standard, sensitivity, specificity, and diagnostic accuracy were higher with CTP than with CCTA (76.5%, 85.9%, and 82.9%, respectively, vs 48.2%, 63.5%, and 59.3%; < .01). The mean effective dose of stress CTP plus CCTA was 10.4 mSv ± 2.7. Conclusion In patients with coronary stents, dynamic CTP improves the diagnostic performance of CCTA in the detection of territory-based ischemia. © RSNA, 2024 See also the editorial by Williams in this issue.
背景
利用冠状动脉CT血管造影（CCTA）检测支架内再狭窄（ISR）具有挑战性，但CT灌注（CTP）已证明在有支架的患者中其诊断准确性优于CCTA。然而，关于动态CTP性能的数据有限，动态CTP可对局部心肌血流进行无创判定。目的：以血流储备分数（FFR）和微血管阻力指数（IMR）分别作为心外膜冠状动脉循环和冠状动脉微循环的参考标准，比较雷加昔布负荷动态CTP与CCTA的诊断性能。材料与方法：2021年1月至2022年6月，这项前瞻性研究纳入了因怀疑ISR或冠状动脉疾病进展而有有创冠状动脉造影指征的支架置入患者。参与者接受了动态负荷心肌CTP及静息CTP加CCTA检查。使用了宽覆盖范围（z轴覆盖范围16 cm）和快速（机架旋转时间0.28秒）的扫描仪。在有创冠状动脉造影过程中，获取FFR和IMR。在基于区域的分析中评估CCTA和CTP的诊断率（可解释区域数除以评估区域数）和准确性，并与FFR和IMR进行比较（研究的主要终点）。结果：该研究纳入了156例连续患者（136例男性[87%]；平均年龄63.1岁±8.2[标准差]），共504个支架。CTP的诊断率高于CCTA（98.7%[799个区域中的789个]对95.6%[799个区域中的764个]，P<0.001）。以FFR作为参考标准，CTP的敏感性、特异性和诊断准确性高于CCTA（分别为89.0%、82.8%和84.7%，对比60.0%、61.9%和61.5%；P<0.001）。以IMR作为参考标准，CTP的敏感性、特异性和诊断准确性高于CCTA（分别为76.5%、85.9%和82.9%，对比48.2%、63.5%和59.3%；P<0.01）。负荷CTP加CCTA的平均有效剂量为10.4 mSv±2.7。结论：在冠状动脉支架置入患者中，动态CTP可提高CCTA在检测基于区域的缺血方面的诊断性能。©RSNA，2024 另见本期Williams的社论。
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