Felix G Meinel1, Julian L Wichmann2, U Joseph Schoepf3, Francesca Pugliese4, Ullrich Ebersberger5, Gladys G Lo6, Yeon Hyeon Choe7, Yining Wang8, Christian Tesche5, Sabrina Segreto9, Wolfgang G Kunz10, Kolja M Thierfelder10, Fabian Bamberg11, Carlo N De Cecco12. 1. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany. 2. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany. 3. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States. Electronic address: schoepf@musc.edu. 4. Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and the London School of Medicine, Queen Mary University of London, UK. 5. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany. 6. Department of Diagnostic and Interventional Radiology, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, China. 7. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 8. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. 9. Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and the London School of Medicine, Queen Mary University of London, UK; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy. 10. Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany. 11. Department of Diagnostic and Interventional Radiology, University Medical Center Tübingen, Tübingen, Germany. 12. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Latina, Italy.
Abstract
BACKGROUND: There is no published data on the prognostic value of global myocardial perfusion values at stress dynamic CT myocardial perfusion imaging (CTMPI). METHODS: Data of 144 patients from 6 centers who had undergone coronary CT angiography (coronary CTA) and CTMPI were assessed. Coronary CTA studies were acquired at rest; CTMPI was performed under vasodilator stress. Coronary CTA data were evaluated for coronary artery stenosis (≥50% luminal narrowing) on a per-vessel basis. Volumes-of-interest were placed over the entire left ventricular myocardium to obtain global myocardial blood flow (MBF), myocardial blood volume (MBV), and volume transfer constant (Ktrans). Follow-up was obtained at 6/12/18 months. Major adverse cardiac events (MACE, defined as cardiac death, non-fatal myocardial infarction, unstable angina requiring hospitalization, and revascularization) served as the endpoint. RESULTS: MACE occurred in 40 patients (nonfatal myocardial infarction, n = 1, unstable angina, n = 13, PCI, n = 23, and CABG, n = 3). Patients with global MBF of <121 mL/100 mL/min were at increased risk for MACE (HR 2.07, 95% confidence interval [CI]: 1.12-3.84, p = 0.02). This association remained significant after adjusting for age, gender, and clinical risk factors (HR 2.17, 95%CI: 1.16-4.06, p = 0.02), after further adjusting for presence of ≥50% stenosis at coronary CTA (HR 2.18, 95%CI: 1.16-4.10, p = 0.02) and when excluding early (<6 months) revascularizations (HR 2.34, 95%CI: 1.01-5.43, p = 0.0486). Global MBV and Ktrans were not independent predictors of MACE. CONCLUSION: Global quantification of left ventricular MBF at stress dynamic CTMPI may have incremental predictive value for future MACE over clinical risk factors and assessment of stenosis at coronary CTA.
BACKGROUND: There is no published data on the prognostic value of global myocardial perfusion values at stress dynamic CT myocardial perfusion imaging (CTMPI). METHODS: Data of 144 patients from 6 centers who had undergone coronary CT angiography (coronary CTA) and CTMPI were assessed. Coronary CTA studies were acquired at rest; CTMPI was performed under vasodilator stress. Coronary CTA data were evaluated for coronary artery stenosis (≥50% luminal narrowing) on a per-vessel basis. Volumes-of-interest were placed over the entire left ventricular myocardium to obtain global myocardial blood flow (MBF), myocardial blood volume (MBV), and volume transfer constant (Ktrans). Follow-up was obtained at 6/12/18 months. Major adverse cardiac events (MACE, defined as cardiac death, non-fatal myocardial infarction, unstable angina requiring hospitalization, and revascularization) served as the endpoint. RESULTS: MACE occurred in 40 patients (nonfatal myocardial infarction, n = 1, unstable angina, n = 13, PCI, n = 23, and CABG, n = 3). Patients with global MBF of <121 mL/100 mL/min were at increased risk for MACE (HR 2.07, 95% confidence interval [CI]: 1.12-3.84, p = 0.02). This association remained significant after adjusting for age, gender, and clinical risk factors (HR 2.17, 95%CI: 1.16-4.06, p = 0.02), after further adjusting for presence of ≥50% stenosis at coronary CTA (HR 2.18, 95%CI: 1.16-4.10, p = 0.02) and when excluding early (<6 months) revascularizations (HR 2.34, 95%CI: 1.01-5.43, p = 0.0486). Global MBV and Ktrans were not independent predictors of MACE. CONCLUSION: Global quantification of left ventricular MBF at stress dynamic CTMPI may have incremental predictive value for future MACE over clinical risk factors and assessment of stenosis at coronary CTA.
Authors: Adam M Alessio; Michael Bindschadler; Janet M Busey; William P Shuman; James H Caldwell; Kelley R Branch Journal: Circ Cardiovasc Imaging Date: 2019-06-14 Impact factor: 7.792
Authors: Felix G Meinel; U Joseph Schoepf; Jacob C Townsend; Brian A Flowers; Lucas L Geyer; Ullrich Ebersberger; Aleksander W Krazinski; Wolfgang G Kunz; Kolja M Thierfelder; Deborah W Baker; Ashan M Khan; Valerian L Fernandes; Terrence X O'Brien Journal: Sci Rep Date: 2018-06-15 Impact factor: 4.379