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Y Dynamic Computed Tomography Myocardial Perfusion Imaging Comparison of Clinical Analysis Methods for the Detection of Vessel-Specific Ischemia

Rossi, A; Wragg, A; Klotz, E; Pirro, F; Moon, JC; Nieman, K; Pugliese, F; (2017) Y Dynamic Computed Tomography Myocardial Perfusion Imaging Comparison of Clinical Analysis Methods for the Detection of Vessel-Specific Ischemia. Circulation: Cardiovascular Imaging , 10 (4) , Article e005505. 10.1161/CIRCIMAGING.116.005505. Green open access

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Abstract

Background—The clinical analysis of myocardial dynamic computed tomography myocardial perfusion imaging lacks standardization. The objective of this prospective study was to compare different analysis approaches to diagnose ischemia in patients with stable angina referred for invasive coronary angiography. Methods and Results—Patients referred for evaluation of stable angina symptoms underwent adenosine-stress dynamic computed tomography myocardial perfusion imaging with a second-generation dual-source scanner. Quantitative perfusion parameters, such as blood flow, were calculated by parametric deconvolution for each myocardial voxel. Initially, perfusion parameters were extracted according to standard 17-segment model of the left ventricle (fully automatic analysis). These were then manually sampled by an operator (semiautomatic analysis). Areas under the receiver-operating characteristic curves of the 2 different approaches were compared. Invasive fractional flow reserve ≤0.80 or diameter stenosis ≥80% on quantitative coronary angiography was used as reference standard to define ischemia. We enrolled 115 patients (88 men; age 57±9 years). There were 72 of 286 (25%) vessels causing ischemia in 52 of 115 (45%) patients. The semiautomatic analysis method was better than the fully automatic method at predicting ischemia (areas under the receiver-operating characteristic curves, 0.87 versus 0.69; P<0.001) with readings obtained in the endocardial myocardium performing better than those in the epicardial myocardium (areas under the receiver-operating characteristic curves, 0.87 versus 0.72; P<0.001). The difference in performance between blood flow, expressed as relative to remote myocardium, and absolute blood flow was not statistically significant (areas under the receiver-operating characteristic curves, 0.90 versus 0.87; P=ns). Conclusions—Endocardial perfusion parameters obtained by semiautomatic analysis of dynamic computed tomography myocardial perfusion imaging may permit robust discrimination between coronary vessels causing ischemia versus not causing ischemia.

Type: Article
Title: Y Dynamic Computed Tomography Myocardial Perfusion Imaging Comparison of Clinical Analysis Methods for the Detection of Vessel-Specific Ischemia
Open access status: An open access version is available from UCL Discovery
DOI: 10.1161/CIRCIMAGING.116.005505
Publisher version: http://doi.org/10.1161/CIRCIMAGING.116.005505
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Angina, stable, coronary angiography, coronary vessels, endocardium, perfusion imaging
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/1557678
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