Incremental Diagnostic Value of Stress Computed Tomography Myocardial Perfusion With Whole-Heart Coverage CT Scanner in Intermediate- to High-Risk Symptomatic Patients Suspected of Coronary Artery Disease

Pontone, Gianluca; Andreini, Daniele; Guaricci, Andrea Igoren; Baggiano, Andrea; Fazzari, Fabio; Guglielmo, Marco; Muscogiuri, Giuseppe; Berzovini, Claudio; Pasquini, Annalisa; Mushtaq, Saima; Conte, Edoardo; Calligaris, Giuseppe; Martini, Stefano De; Ferrari, Cristina; Galli, Stefano; Grancini, Luca; Ravagnani, Paolo; Teruzzi, Giovanni; Trabattoni, Daniela; Fabbiocchi, Franco; Lualdi, Alessandro; Montorsi, Piero; Rabbat, Mark; Bartorelli, Antonio L.; Pepi, Mauro

doi:10.1016/j.jcmg.2017.10.025

Cited by 89 publications

(47 citation statements)

References 38 publications

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“…CTP is useful for assessment of the hemodynamic significance and effective classification of coronary lesions, allowing integrated evaluation of CAD when combined with CTA ( Fig. 8) [30,79]. Moreover, myocardial perfusion can be quantified and the effect of treatment after revascularization can be evaluated [35,80].…”

Section: Advantages Of Ctpmentioning

confidence: 99%

Computed tomographic evaluation of myocardial ischemia

et al. 2020

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Myocardial ischemia is caused by a mismatch between myocardial oxygen consumption and oxygen delivery in coronary artery disease (CAD). Stratification and decision-making based on ischemia improves the prognosis in patients with CAD. Non-invasive tests used to evaluate myocardial ischemia include stress electrocardiography, echocardiography, single-photon emission computed tomography, and magnetic resonance imaging. Invasive fractional flow reserve is considered the reference standard for assessment of the hemodynamic significance of CAD. Computed tomography (CT) angiography has emerged as a first-line imaging modality for evaluation of CAD, particularly in the population at low to intermediate risk, because of its high negative predictive value; however, CT angiography does not provide information on the hemodynamic significance of stenosis, which lowers its specificity. Emerging techniques, e.g., CT perfusion and CT-fractional flow reserve, help to address this limitation of CT, by determining the hemodynamic significance of coronary artery stenosis. CT perfusion involves acquisition during the first pass of contrast medium through the myocardium following pharmacological stress. CTfractional flow reserve uses computational fluid dynamics to model coronary flow, pressure, and resistance. In this article, we review these two functional CT techniques in the evaluation of myocardial ischemia, including their principles, technology, advantages, limitations, pitfalls, and the current evidence.

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Section: Advantages Of Ctpmentioning

confidence: 99%

Computed tomographic evaluation of myocardial ischemia

et al. 2020

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“…We present here a very preliminary result about the comparison of the perfusion obtained with the proposed model and a Myocardial Blood Flow (MBF) map of an healthy person obtained by stress myocardial computed tomography perfusion (stress-CTP) at Centro Cardiologico Monzino, Milan, Italy. STRESS-CTP is an effective strategy to perform the diagnosis of coronary artery disease [22,50] and allows to measure the myocardial perfusion highlighting the regions scarcely perfused.…”

Section: Test Iii: Preliminary Comparison With Clinical Datamentioning

confidence: 99%

A computational model applied to myocardial perfusion in the human heart: From large coronaries to microvasculature

Gregorio

Fedele

Corno

et al. 2021

Journal of Computational Physics

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“…Recently, two methods for the evaluation of the functional relevance of stenosis by cardiac CT have been introduced in the clinical field, stress myocardial computed tomography perfusion (CTP), and fractional flow reserve computed tomography (FFRCT) [ 24 , 82 , 100 ]. Stress CTP demonstrated similar performance to nuclear imaging and additional diagnostic value to CCTA alone as compared to invasive FFR [ 22 ]. Software to determine FFR from CCT dataset (FFR-CT) using computational fluid dynamics laws has been recently developed.…”

Section: Future Perspectives For Prognosis Improvementmentioning

confidence: 99%

“…Coronary computed tomographic angiography (CCTA) is increasingly emerging as a noninvasive technique that enables direct anatomic visualization of atherosclerotic stenosis in the epicardial coronary arteries, with low radiation exposure [ 15 – 18 ]. Although such factors (i.e., high heart rate, arrhythmia, obesity, and high coronary calcium burden) may limit overall evaluability [ 19 – 21 ], the significant improvement in technologies during the last past decades has opened new perspectives in cardiac imaging permitting the acquisition within few seconds and with a higher spatial resolution [ 22 – 24 ]. CCTA has proven to have a high diagnostic accuracy compared with the invasive coronary angiography (ICA), which represents until now the standard of reference for evaluating coronary artery disease [ 25 – 33 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value and Therapeutic Perspectives of Coronary CT Angiography: A Literature Review

Carità

Guaricci

Muscogiuri

et al. 2018

BioMed Research International

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Coronary stenosis severity is both a powerful and a still debated predictor of prognosis in coronary artery disease. Coronary computed tomographic angiography (CCTA) has emerged as a noninvasive technique that enables anatomic visualization of coronary artery disease (CAD). CCTA with newer applications, plaque characterization and physiologic/functional evaluation, allows a comprehensive diagnostic and prognostic assessment of otherwise low-intermediate subjects for primary prevention. CCTA measures the overall plaque burden, differentiates plaque subtypes, and identifies high-risk plaque with good reproducibility. Research in this field may also advance towards an era of personalized risk prediction and individualized medical therapy. It has been demonstrated that statins may delay plaque progression and change some plaque features. The potential effects on plaque modifications induced by other medical therapies have also been investigated. Although it is not currently possible to recommend routinely serial scans to monitor the therapeutic efficacy of medical interventions, the plaque modulation, as a part of risk modification, appears a feasible strategy. In this review we summarize the current evidence regarding vulnerable plaque and effects of lipid lowering therapy on morphological features of CAD. We also discuss the potential ability of CCTA to characterize coronary atherosclerosis, stratify prognosis of asymptomatic subjects, and guide medical therapy.

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Incremental Diagnostic Value of Stress Computed Tomography Myocardial Perfusion With Whole-Heart Coverage CT Scanner in Intermediate- to High-Risk Symptomatic Patients Suspected of Coronary Artery Disease

Abstract: The inclusion of stress CTP for the evaluation of patients with an intermediate to high risk for CAD is feasible and improved the diagnostic performance of coronary CTA for detecting functionally significant CAD.

Cited by 89 publications

References 38 publications

Computed tomographic evaluation of myocardial ischemia

Computed tomographic evaluation of myocardial ischemia

A computational model applied to myocardial perfusion in the human heart: From large coronaries to microvasculature

Prognostic Value and Therapeutic Perspectives of Coronary CT Angiography: A Literature Review

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