Lihua Yu1, Zhigang Lu2, Xu Dai1, Chengxing Shen2, Lei Zhang3, Jiayin Zhang3. 1. Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. 2. Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. 3. Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Abstract
BACKGROUND: Myocardial blood flow (MBF), CT fractional flow reserve (CT-FFR) and high-risk plaque (HRP) features have been revealed to be associated with patients' prognosis. However, direct intra-individual comparison of these CT-derived parameters has not been explored yet. The aim of this study was to investigate the prognostic value of CT-derived MBF, CT-FFR and HRP features for predicting major adverse cardiac events (MACEs). METHODS: Consecutive patients with chest pain and intermediate-to-high pre-test probability of coronary artery disease (CAD) were prospectively enrolled. All patients were referred for dynamic CT myocardial perfusion imaging (CT-MPI) + coronary CT angiography (CCTA) and followed up for at least 1 year. MBFischemic (mean MBF of all ischemic segments), MBFratio (MBF of ischemic segments/MBF of reference segments), CT-FFR and HRP features were measured and multivariate analysis was used to evaluate the predictive value of all above parameters for MACEs. RESULTS: One hundred and forty-two patients were included into final analysis. MBFischemic and MBFratio was significantly lower in patients with MACE compared to patients without MACE (87 vs. 153 mL/100 mL/min and 0.64 vs. 0.95, both P<0.001). Similarly, CT-FFR was also markedly lower in patients with MACE (0.58 vs. 0.88, P<0.001) whereas coronary artery calcium score (CACS) was significantly higher (1,038.9 vs. 34.2, P<0.001). According to ROC curve analysis, MBFischemic, MBFratio and CACS had largest area under curve (AUC =0.872, 0.855 and 0.813 respectively, all P<0.001) for identifying patients with MACE. After adjusted by multivariate analysis, MBFischemic (hazard ratio =23.382, P=0.003) and CACS (hazard ratio =3.759, P=0.029) were revealed to be the independent predictors for MACE where CT-FFR and HRP features failed to have prognostic value. CONCLUSIONS: MBFischemic derived from dynamic CT-MPI was the strongest predictor for MACE, followed by CACS. MBFischemic outperformed HRP features and CT-FFR for prediction of unfavorable clinical outcome. 2021 Cardiovascular Diagnosis and Therapy. All rights reserved.
BACKGROUND: Myocardial blood flow (MBF), CT fractional flow reserve (CT-FFR) and high-risk plaque (HRP) features have been revealed to be associated with patients' prognosis. However, direct intra-individual comparison of these CT-derived parameters has not been explored yet. The aim of this study was to investigate the prognostic value of CT-derived MBF, CT-FFR and HRP features for predicting major adverse cardiac events (MACEs). METHODS: Consecutive patients with chest pain and intermediate-to-high pre-test probability of coronary artery disease (CAD) were prospectively enrolled. All patients were referred for dynamic CT myocardial perfusion imaging (CT-MPI) + coronary CT angiography (CCTA) and followed up for at least 1 year. MBFischemic (mean MBF of all ischemic segments), MBFratio (MBF of ischemic segments/MBF of reference segments), CT-FFR and HRP features were measured and multivariate analysis was used to evaluate the predictive value of all above parameters for MACEs. RESULTS: One hundred and forty-two patients were included into final analysis. MBFischemic and MBFratio was significantly lower in patients with MACE compared to patients without MACE (87 vs. 153 mL/100 mL/min and 0.64 vs. 0.95, both P<0.001). Similarly, CT-FFR was also markedly lower in patients with MACE (0.58 vs. 0.88, P<0.001) whereas coronary artery calcium score (CACS) was significantly higher (1,038.9 vs. 34.2, P<0.001). According to ROC curve analysis, MBFischemic, MBFratio and CACS had largest area under curve (AUC =0.872, 0.855 and 0.813 respectively, all P<0.001) for identifying patients with MACE. After adjusted by multivariate analysis, MBFischemic (hazard ratio =23.382, P=0.003) and CACS (hazard ratio =3.759, P=0.029) were revealed to be the independent predictors for MACE where CT-FFR and HRP features failed to have prognostic value. CONCLUSIONS: MBFischemic derived from dynamic CT-MPI was the strongest predictor for MACE, followed by CACS. MBFischemic outperformed HRP features and CT-FFR for prediction of unfavorable clinical outcome. 2021 Cardiovascular Diagnosis and Therapy. All rights reserved.
Authors: Manuel D Cerqueira; Neil J Weissman; Vasken Dilsizian; Alice K Jacobs; Sanjiv Kaul; Warren K Laskey; Dudley J Pennell; John A Rumberger; Thomas Ryan; Mario S Verani Journal: Circulation Date: 2002-01-29 Impact factor: 29.690
Authors: Nitesh Nerlekar; Francis J Ha; Caitlin Cheshire; Hashrul Rashid; James D Cameron; Dennis T Wong; Sujith Seneviratne; Adam J Brown Journal: Circ Cardiovasc Imaging Date: 2018-01 Impact factor: 7.792
Authors: Robert Detrano; Alan D Guerci; J Jeffrey Carr; Diane E Bild; Gregory Burke; Aaron R Folsom; Kiang Liu; Steven Shea; Moyses Szklo; David A Bluemke; Daniel H O'Leary; Russell Tracy; Karol Watson; Nathan D Wong; Richard A Kronmal Journal: N Engl J Med Date: 2008-03-27 Impact factor: 91.245
Authors: Marly van Assen; Gert Jan Pelgrim; Carlo N De Cecco; J Marco A Stijnen; Beatrice M Zaki; Matthijs Oudkerk; Rozemarijn Vliegenthart; U Joseph Schoepf Journal: Eur J Radiol Date: 2018-11-24 Impact factor: 3.528
Authors: Maria Emfietzoglou; Michail C Mavrogiannis; Athanasios Samaras; Georgios P Rampidis; George Giannakoulas; Polydoros N Kampaktsis Journal: Front Cardiovasc Med Date: 2022-07-15