Computed Tomography Angiography and Myocardial Computed Tomography Perfusion in Patients With Coronary Stents

Rief, Matthias; Zimmermann, Elke; Stenzel, Fabian; Martus, Peter; Stangl, Karl; Greupner, Johannes; Knebel, Fabian; Kranz, Anisha; Schlattmann, Peter; Laule, Michael; Dewey, Marc

doi:10.1016/j.jacc.2013.03.088

Cited by 92 publications

(57 citation statements)

References 32 publications

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“…Our finding explains the extremely low PPV of CTP for the detection of in-stent restenosis as reported by Rief et al 39 For CTP to be truly useful in the evaluation of in-stent restenosis, differentiation between ischemia and infarction is necessary. The comprehensive CT study protocol in this study can provide discrimination of myocardial ischemia and infarction.…”

Section: Discussionsupporting

confidence: 67%

Diagnostic Accuracy of Endocardial-to-Epicardial Myocardial Blood Flow Ratio for the Detection of Significant Coronary Artery Disease With Dynamic Myocardial Perfusion Dual-Source Computed Tomography

Goto

Kitagawa

Uno

et al. 2017

Circ J

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limited response to vasodilator stress, resulting in globally reduced hyperemic MBF. 15 Because the endocardial layer is most susceptible to ischemia, 16,17 the ratio of endocardial MBF and epicardial MBF might be a more useful indicator of flow-limiting CAD.The purpose of this study was to investigate whether the transmural ratio of absolute MBF can improve the accuracy of CTP when compared with absolute MBF for the detection of flow-limiting CAD, as defined by fractional flow reserve (FFR). We also explored the prevalence of myocardial scar in candidates for CTP and its effect on the diagnostic performance of CTP. Methods Study PopulationIn the comprehensive cardiac CT registry at Mie University C oronary computed tomography angiography (CCTA) allows noninvasive assessment of the morphology of coronary artery stenosis and is highly useful for ruling out the presence of obstructive coronary artery disease (CAD). 1,2 However, because obstructive stenosis identified by CCTA is a poor predictor of the presence of myocardial ischemia, a functional test is generally recommended to investigate the hemodynamic significance of the stenotic lesion. 3 Stress dynamic CT perfusion (CTP) with absolute quantification of myocardial blood flow (MBF) is a new noninvasive technique for the assessment of myocardial ischemia. 4,5 Previous CTP studies used absolute MBF thresholds in mL/100 g/min to discriminate flow-limiting CAD, 6-10 but the absolute MBF can vary because of factors other than the degree of coronary artery stenosis. Yoshitaka Goto, MD; Kakuya Kitagawa, MD; Mio Uno, MD; Shiro Nakamori, MD; Tatsuro Ito, MD; Naoki Nagasawa, PhD; Kaoru Dohi, MD; Hajime Sakuma, MD Background: Previous dynamic stress computed tomography perfusion (CTP) studies used absolute myocardial blood flow (MBF in mL/100 g/min) as a threshold to discriminate flow-limiting coronary artery disease (CAD), but absolute MBF can be vary because of multiple factors. The aim of this study was to compare the diagnostic performance of absolute MBF and the transmural perfusion ratio (TPR) for the detection of flow-limiting CAD, and to clarify the influence of CT delayed enhancement (CTDE) on the diagnostic performance of CTP.

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Section: Discussionsupporting

confidence: 67%

Diagnostic Accuracy of Endocardial-to-Epicardial Myocardial Blood Flow Ratio for the Detection of Significant Coronary Artery Disease With Dynamic Myocardial Perfusion Dual-Source Computed Tomography

Goto

Kitagawa

Uno

et al. 2017

Circ J

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“…In this regard, Rief et al demonstrated in 92 patients that static CTP significantly improved the detection of instent restenosis (area under the curve from 0.69 to 0.92; P<0.0001) by reducing the number of non-diagnostic CTA examinations (62).…”

Section: Clinical Evidencementioning

confidence: 99%

Myocardial CT perfusion imaging for ischemia detection

Carrascosa

Capuñay

2017

Cardiovasc. Diagn. Ther.

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“…[92][93][94] CT perfusion may improve the overall diagnostic accuracy of cardiac CT, particularly in the interpretation of intermediate (30-70%) stenosis, 95 in the evaluation of stent patency, 96 and of diffuse atherosclerotic involvement with densely calcified plaques 97 ( Figure 5). …”

Section: Plaque Features Associated With Vulnerabilitymentioning

confidence: 99%

Chest pain: coronary CT in the ER

Maffei¹,

Seitun²,

Guaricci³

et al. 2016

BJR

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Cardiac CT has developed into a robust clinical tool during the past 15 years. Of the fields in which the potential of cardiac CT has raised more interest is chest pain in acute settings. In fact, the possibility to exclude with high reliability obstructive coronary artery disease (CAD) in patients at low-to-intermediate risk is of great interest both from the clinical standpoint and from the management standpoint. Several other modalities, with or without imaging, have been used during the past decades in the settings of new onset chest pain or in acute chest pain for both diagnostic and prognostic assessment of CAD. Each one has advantages and disadvantages. Most imaging modalities also focus on inducible ischaemia to guide referral to invasive coronary angiography. The advent of cardiac CT has introduced a new practice diagnostic paradigm, being the most accurate non-invasive method for identification and exclusion of CAD. Furthermore, the detection of subclinical CAD and plaque imaging offer the opportunity to improve risk stratification. Moreover, recent advances of the latest generation CT scanners allow combining both anatomical and functional imaging by stress myocardial perfusion. The role of cardiac CT in acute settings is already important and will become progressively more important in the coming years.

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Computed Tomography Angiography and Myocardial Computed Tomography Perfusion in Patients With Coronary Stents

Abstract: Combined coronary CTA and myocardial CTP improves diagnosis of CAD and in-stent restenosis in patients with stents compared with CTA alone. (Coronary Artery Stent Evaluation With 320-Slice Computed Tomography-The CArS 320 Study [CARS-320]; NCT00967876).

Cited by 92 publications

References 32 publications

Diagnostic Accuracy of Endocardial-to-Epicardial Myocardial Blood Flow Ratio for the Detection of Significant Coronary Artery Disease With Dynamic Myocardial Perfusion Dual-Source Computed Tomography

Diagnostic Accuracy of Endocardial-to-Epicardial Myocardial Blood Flow Ratio for the Detection of Significant Coronary Artery Disease With Dynamic Myocardial Perfusion Dual-Source Computed Tomography

Myocardial CT perfusion imaging for ischemia detection

Chest pain: coronary CT in the ER

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