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Prognostic Value of Stress Dynamic Computed Tomography Perfusion With Computed Tomography Delayed Enhancement
Affiliation:1. Department of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan;2. Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan;3. Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
Abstract:ObjectivesThis study sought to evaluate the prognostic value of stress dynamic computed tomography (CT) perfusion (CTP) with CT delayed enhancement (CTDE) in patients with suspected or known coronary artery disease (CAD) and in subgroups of patients with stent, heavy calcification, or stenosis.BackgroundThe prognostic value of stress dynamic CTP with CTDE is unknown.MethodsParticipants were 540 patients with suspected or known CAD. Major adverse cardiac event(s) (MACE) consisted of cardiac death, nonfatal myocardial infarction, unstable angina, or hospitalization for congestive heart failure. Ischemic score was calculated by scoring the reduction of normalized myocardial blood flow in 16 segments excluding areas of myocardial scarring. Ischemic perfusion defect (IPD) was defined as Ischemic score ≥4. Scar score was also calculated by scoring the transmural extent of scarring in each segment on CTDE.ResultsDuring a median follow-up of 2.9 years, 43 MACEs occurred. By adding IPD to obstructive CAD (≥50% stenosis) on coronary CT angiography, the concordance index for predicting MACEs increased from 0.73 to 0.82 in patients with suspected CAD (p = 0.028) and from 0.61 to 0.73 in patients with known CAD (p = 0.004). IPD and scar score of ≥4 were independent predictors when adjusted for each other in patients with suspected (adjusted hazard ratios: 7.5 [p < 0.001] and 3.0 [p = 0.034], respectively) or known CAD (adjusted hazard ratios: 4.4 [p = 0.001] and 3.2 [p = 0.024], respectively). Patients with IPD had a higher annualized event rate than those without IPD in subgroups of those with stent (11.5% vs. 2.6%; p < 0.001), heavy calcification (13.3% vs. 3.1%; p < 0.001), 50% to 69% stenosis (8.8% vs. 1.0%; p < 0.001), or ≥70% stenosis (12.4% vs. 3.6%; p < 0.001).ConclusionsStress dynamic CTP with CTDE had incremental prognostic value over CT angiography in each group with suspected or known CAD and was prognostically useful in subgroups of patients with stent, heavy calcification, or obstructive CAD. IPD and myocardial scarring may play complementary roles in prognostic stratification.
Keywords:CT delayed enhancement  dynamic CT perfusion  prognostic value  ATP"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0030"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  adenosine triphosphate  CABG"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0040"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  coronary artery bypass grafting  CAD"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0050"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  coronary artery disease  CCS"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0060"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  coronary calcium score  CI"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0070"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  confidence interval  CMR"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0080"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  cardiac magnetic resonance  CT"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0090"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  computed tomography  CT-FFR"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0130"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  computed tomography–derived fractional flow reserve  CTA"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0100"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  computed tomography angiography  CTDE"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0110"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  computed tomography delayed enhancement  CTP"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0120"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  computed tomography perfusion  ECG"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0140"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  electrocardiogram  FFR"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0150"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  fractional flow reserve  HR"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0160"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  hazard ratio  IPD"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0170"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  ischemic perfusion defect  LAD"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0180"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  left anterior descending artery  MACE"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0190"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  major adverse cardiac event(s)  MBF"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0200"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  myocardial blood flow  MI"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0210"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  myocardial infarction  ROC"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  kwrd0220"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  receiver-operating characteristic curve
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