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Kawaguchi Y, Kato S, Horita N, Utsunomiya D. Value of Dynamic Computed Tomography Myocardial Perfusion in CAD: A Systematic Review and Meta-analysis. Eur Heart J Cardiovasc Imaging 2024:jeae118. [PMID: 38693883 DOI: 10.1093/ehjci/jeae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024] Open
Abstract
AIMS Dynamic stress computed tomography (CT) perfusion is a non-invasive method for quantifying myocardial ischemia by assessing myocardial blood flow (MBF). In this meta-analysis, we evaluated the diagnostic accuracy of dynamic CT perfusion for the detection of significant coronary artery disease (CAD) across various CT scanners, obese patients, and its prognostic value. METHODS AND RESULTS We systematically searched PubMed, Embase, Web of Science, and Cochrane library for published studies evaluating the accuracy of CT myocardial perfusion in diagnosing functional significant ischemia by invasive fractional flow reserve. The diagnostic performance of dynamic CT perfusion in detecting ischemia was evaluated using a summary receiver operating characteristic (sROC) curve. A total of 23 studies underwent meta- analysis. In myocardial region without ischemia, MBF was measured at 1.44 ml/min/g (95% confidence interval [CI]: 1.13-1.75), while in region with ischemia, it was 0.94 ml/min/g (95% CI: 0.80-1.08) (p<0.001). On the patient-based analysis, the area under the sROC curve of CT-MBF was 0.93, with a sensitivity of 0.84 and specificity of 0.88. Differences in CT type (dual source vs. single source), and body mass index (BMI) did not significantly affect the diagnostic performance. The pooled hazard ratio of dynamic CT perfusion for predicting adverse events was 4.98 (95%CI: 2.08-11.93, p=<0.001, I2=61%, p for heterogeneity = 0.07). CONCLUSIONS Dynamic CT perfusion has high diagnostic performance in the quantitative assessment of ischemia and detection of functional myocardial ischemia as defined by invasive FFR, and may be useful in risk stratification of CAD patients.
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Affiliation(s)
- Yuma Kawaguchi
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine
| | - Shingo Kato
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine
| | | | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine
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Liu T, Ding M, Sun D, Zhang H, Guo L, Li Y, Zhao H, Zhu F. The association between heart rate reserve and impaired coronary flow velocity reserve: a study based on adenosine stress echocardiography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1037-1046. [PMID: 34919164 DOI: 10.1007/s10554-021-02480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
This study was to explore the correlation between heart rate reserve (HRR) to coronary flow velocity reserve (CFVR), using adenosine stress echocardiography (SE), in patients with angina and no obstructive coronary artery disease (ANOCA). 111 ANOCA patients underwent adenosine SE were enrolled, which were divided into two groups, impaired CFVR group (CFVR < 2) and control groups (CFVR ≥ 2). The relationships between HRR and impaired CFVR were explored in total and subgroup to sex. A reduced HRR during adenosine infusion was seen in ANOCA patients with impaired CFVR (25.73 ± 8.39 vs. 34.30 ± 19.93, P < 0.001). Compared to respective controls, the blunted HRR to adenosine was more pronounced in female patients (women: 27.21 ± 8.01 vs. 39.48 ± 10.57, P < 0.001; men: 24.05 ± 8.70 vs. 29.12 ± 8.69, P = 0.041). A strong association between CFVR and a blunted HRR was observed in women (r = 0.46, P < 0.001), while no association in men (r = 0.18, P = 0.199). In female, a multivariate logistic regression identified HRR as the strongest negative predictor of impaired CFVR [HR (95% CI) = 0.854 (0.764-0.956), P = 0.006]. Based on the ROC curve, HRR < 35% was a strong indicator of impaired CFVR, with AUC of 0.838, sensitivity of 70%, and specificity of 87% in females. A blunted HRR was seen in patients with impaired CFVR, with a most pronounced effect being seen in female patients. The blunted HRR < 35% is intricately linked to impaired CFVR in women with ANOCA beyond the value of traditional risk factors, which could ultimately contribute to risk stratification of impaired CFVR in such patients.
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Affiliation(s)
- Tingting Liu
- Faculty of Medical Imaging and Nuclear Medicine, Graduate School of Dalian Medical University, Dalian, 116044, China
- Department of Cardiac Function, People's Hospital of Liaoning Province, Building 1, No.33, Wenyi Road, Shenhe District, Shenyang, 110000, China
| | - Mingyan Ding
- Department of Cardiac Function, People's Hospital of Liaoning Province, Building 1, No.33, Wenyi Road, Shenhe District, Shenyang, 110000, China
| | - Dandan Sun
- Department of Cardiac Function, People's Hospital of Liaoning Province, Building 1, No.33, Wenyi Road, Shenhe District, Shenyang, 110000, China
| | - Huihui Zhang
- Department of Cardiac Function, People's Hospital of Liaoning Province, Building 1, No.33, Wenyi Road, Shenhe District, Shenyang, 110000, China
| | - Lijuan Guo
- Department of Cardiac Function, People's Hospital of Liaoning Province, Building 1, No.33, Wenyi Road, Shenhe District, Shenyang, 110000, China
| | - Ying Li
- Department of Cardiac Function, People's Hospital of Liaoning Province, Building 1, No.33, Wenyi Road, Shenhe District, Shenyang, 110000, China
| | - Hanzhang Zhao
- Department of Cardiac Function, People's Hospital of Liaoning Province, Building 1, No.33, Wenyi Road, Shenhe District, Shenyang, 110000, China
| | - Fang Zhu
- Department of Cardiac Function, People's Hospital of Liaoning Province, Building 1, No.33, Wenyi Road, Shenhe District, Shenyang, 110000, China.
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