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Heart. 2013 Jul;99(14):1004-11. doi: 10.1136/heartjnl-2013-303794. Epub 2013 May 14.

CT stress perfusion imaging for detection of haemodynamically relevant coronary stenosis as defined by FFR.

Author information

1
Department of Cardiology, University Hospital of Munich, Bayern, Germany. martin.greif@med.uni-muenchen.de

Abstract

OBJECTIVES:

To evaluate the diagnostic accuracy (DA) of CT-myocardial perfusion imaging (CT-MPI) and a combined approach with CT angiography (CTA) for the detection of haemodynamically relevant coronary stenoses in patients with both suspected and known coronary artery disease.

DESIGN:

Prospective, non-randomised, diagnostic study.

SETTING:

Academic hospital-based study.

PATIENTS:

65 patients (42 men age 70.4±9) with typical or atypical chest pain.

INTERVENTIONS:

CTA and CT-MPI with adenosine stress using a fast dual-source CT system. At subsequent invasive angiography, FFR measurement was performed in coronary arteries to define haemodynamic relevance of stenosis.

MAIN OUTCOME MEASURES:

We tried to correlate haemodynamically relevant stenosis (FFR < 0.80) to a reduced myocardial blood flow (MBF) as assessed by CT-MPI and determined the DA of CT-MPI for the detection of haemodynamically relevant stenosis.

RESULTS:

Sensitivity and negative predictive value (NPV) of CTA alone were very high (100% respectively) for ruling out haemodynamically significant stenoses, specificity, Positive predictive value (PPV) and DA were low (43.8, 67.3 and 72%, respectively). CT-MPI showed a significant increase in specificity, PPV and DA for the detection of haemodynamically relevant stenoses (65.6, 74.4 and 81.5%, respectively) with persisting high sensitivity and NPV for ruling out haemodynamically relevant stenoses (97% and 95.5% respectively). The combination of CTA and CT-MPI showed no further increase in detection of haemodynamically significant stenosis compared with CT-MPI alone.

CONCLUSIONS:

Our data suggest that CT-MPI permits the detection of haemodynamically relevant coronary artery stenoses with a moderate DA. CT may, therefore, allow the simultaneous assessment of both coronary morphology and function.

KEYWORDS:

Imaging and diagnostics

PMID:
23674364
DOI:
10.1136/heartjnl-2013-303794
[Indexed for MEDLINE]
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