Top

Cardiovascular Intervention and Therapeutics

Published in:

Open Access 01-10-2020 | Computed Tomography | Original Article

Coronary artery stenosis-related perfusion ratio using dynamic computed tomography myocardial perfusion imaging: a pilot for identification of hemodynamically significant coronary artery disease

Authors: Natsumi Kuwahara, Yuki Tanabe, Teruhito Kido, Akira Kurata, Teruyoshi Uetani, Hitomi Ochi, Naoto Kawaguchi, Tomoyuki Kido, Shuntaro Ikeda, Osamu Yamaguchi, Migiwa Asano, Teruhito Mochizuki

Published in: Cardiovascular Intervention and Therapeutics | Issue 4/2020

Abstract

The purpose of this study was to evaluate the feasibility of the stenosis-related quantitative perfusion ratio (QPR) for detecting hemodynamically significant coronary artery disease (CAD). Twenty-seven patients were retrospectively enrolled. All patients underwent dynamic myocardial computed tomography perfusion (CTP) and coronary computed tomography angiography (CTA) before invasive coronary angiography (ICA) measuring the fractional flow reserve (FFR). Coronary lesions with FFR ≤ 0.8 were defined as hemodynamically significant CAD. The myocardial blood flow (MBF) was calculated using dynamic CTP data, and CT-QPR was calculated as the CT-MBF relative to the reference CT-MBF. The stenosis-related CT-MBF and QPR were calculated using Voronoi diagram-based myocardial segmentation from coronary CTA data. The relationships between FFR and stenosis-related CT-MBF or QPR and the diagnostic performance of the stenosis-related CT-MBF and QPR were evaluated. Of 81 vessels, FFR was measured in 39 vessels, and 20 vessels (51%) in 15 patients were diagnosed as hemodynamically significant CAD. The stenosis-related CT-QPR showed better correlation (r = 0.70, p < 0.05) than CT-MBF (r = 0.56, p < 0.05). Sensitivity and specificity for detecting hemodynamically significant CAD were 95% and 58% for CT-MBF, and 95% and 90% for CT-QPR, respectively. The area under the receiver operating characteristic curve for the CT-QPR was significantly higher than that for the CT-MBF (0.94 vs. 0.79; p < 0.05). The stenosis-related CT-QPR derived from dynamic myocardial CTP and coronary CTA showed a better correlation with FFR and a higher diagnostic performance for detecting hemodynamically significant CAD than the stenosis-related CT-MBF.

Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359:2324–36. https://doi.org/10.1056/NEJMoa0806576.CrossRefPubMed

Min JK, Shaw LJ, Berman DS. The present state of coronary computed tomography angiography a process in evolution. J Am Coll Cardiol. 2010;55:957–65. https://doi.org/10.1016/j.jacc.2009.08.087.CrossRefPubMed

Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949–3003. https://doi.org/10.1093/eurheartj/eht296.CrossRefPubMed

Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’ t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24. https://doi.org/10.1056/nejmoa0807611.CrossRefPubMed

Celeng C, Leiner T, Maurovich-Horvat P, Merkely B, de Jong P, Dankbaar JW, et al. Anatomical and functional computed tomography for diagnosing hemodynamically significant coronary artery disease: a meta-analysis. JACC Cardiovasc Imaging. 2019;12:1316–25. https://doi.org/10.1016/j.jcmg.2018.07.022.CrossRefPubMed

Hamon M, Geindreau D, Guittet L, Bauters C, Hamon M. Additional diagnostic value of new CT imaging techniques for the functional assessment of coronary artery disease: a meta-analysis. Eur Radiol. 2019;29:3044–61. https://doi.org/10.1007/s00330-018-5919-8.CrossRefPubMed

Lu M, Wang S, Sirajuddin A, Arai AE, Zhao S. Dynamic stress computed tomography myocardial perfusion for detecting myocardial ischemia: a systematic review and meta-analysis. Int J Cardiol. 2018;258:325–31. https://doi.org/10.1016/j.ijcard.2018.01.095.CrossRefPubMed

Byrne C, Kühl JT, Zacho M, Nordestgaard BG, Fuchs A, Frestad D, et al. Sex- and age-related differences of myocardial perfusion at rest assessed with multidetector computed tomography. J Cardiovasc Comput Tomogr. 2013;7:94–101. https://doi.org/10.1016/j.jcct.2013.01.010.CrossRefPubMed

Danad I, Raijmakers PG, Appelman YE, Harms HJ, de Haan S, van den Oever ML, et al. Coronary risk factors and myocardial blood flow in patients evaluated for coronary artery disease: a quantitative [¹⁵O] H₂O PET/CT study. Eur J Nucl Med Mol Imaging. 2012;39:102–12. https://doi.org/10.1007/s00259-011-1956-0.CrossRefPubMed

10.

Kurata A, Kono A, Sakamoto T, Kido T, Mochizuki T, Higashino H, et al. Quantification of the myocardial area at risk using coronary CT angiography and Voronoi algorithm-based myocardial segmentation. Eur Radiol. 2015;25:49–57. https://doi.org/10.1007/s00330-014-3388-2.CrossRefPubMed

11.

Ide S, Sumitsuji S, Yamaguchi O, Sakata Y. Cardiac computed tomography-derived myocardial mass at risk using the Voronoi-based segmentation algorithm: a histological validation study. J Cardiovasc Comput Tomogr. 2017;11:179–82. https://doi.org/10.1016/j.jcct.2017.04.007.CrossRefPubMed

12.

Tanabe Y, Kido T, Uetani T, Kurata A, Kono T, Ogimoto A, et al. Differentiation of myocardial ischemia and infarction assessed by dynamic computed tomography perfusion imaging and comparison with cardiac magnetic resonance and single-photon emission computed tomography. Eur Radiol. 2016;26:3790–801. https://doi.org/10.1007/s00330-016-4238-1.CrossRefPubMed

13.

Tomizawa N, Fujino Y, Kamitani M, Chou S, Yamamoto K, Inoh S, et al. Longer diabetes duration reduces myocardial blood flow in remote myocardium assessed by dynamic myocardial CT perfusion. J Diabetes Compl. 2018;32:609–15. https://doi.org/10.1016/j.jdiacomp.2018.03.003.CrossRef

14.

Tomizawa N, Chou S, Fujino Y, Kamitani M, Yamamoto K, Inoh S, et al. Feasibility of dynamic myocardial CT perfusion using single-source 64-row CT. J Cardiovasc Comput Tomogr. 2019;13:55–61. https://doi.org/10.1016/j.jcct.2018.10.003.CrossRefPubMed

15.

Seike F, Uetani T, Nishimura K, Kawakami H, Higashi H, Aono J, et al. Intracoronary optical coherence tomography-derived virtual fractional flow reserve for the assessment of coronary artery disease. Am J Cardiol. 2017;120:1772–9. https://doi.org/10.1016/j.amjcard.2017.07.083.CrossRefPubMed

16.

Fearon WF, Tonino PA, De Bruyne B, Siebert U, Pijls NH, FAME Study Investigators. Rationale and design of the Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) study. Am Heart J. 2007;154:632–6. https://doi.org/10.1016/j.ahj.2007.06.012.CrossRefPubMed

17.

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.CrossRef

18.

NIPPON DATA80 Research Group. Risk assessment chart for death from cardiovascular disease based on a 19-year follow-up study of a Japanese representative population. Circ J. 2006;70:1249–55. https://doi.org/10.1253/circj.70.1249.CrossRef

19.

Takx RA, Blomberg BA, El Aidi H, Habets J, de Jong PA, Nagel E, et al. Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. Circ Cardiovasc Imaging. 2015;8:e002666. https://doi.org/10.1161/CIRCIMAGING.114.002666.CrossRefPubMed

20.

Lee JM, Kim CH, Koo BK, Hwang D, Park J, Zhang J, et al. Integrated myocardial perfusion imaging diagnostics improve detection of functionally significant coronary artery stenosis by ¹³N-ammonia positron emission tomography. Circ Cardiovasc Imaging. 2016;9:e004768. https://doi.org/10.1161/CIRCIMAGING.116.004768.CrossRefPubMed

21.

Kono AK, Coenen A, Lubbers M, Kurata A, Rossi A, Dharampal A, et al. Relative myocardial blood flow by dynamic computed tomographic perfusion imaging predicts hemodynamic significance of coronary stenosis better than absolute blood flow. Invest Radiol. 2014;49:801–7. https://doi.org/10.1097/RLI.0000000000000087.CrossRefPubMed

22.

Goto Y, Kitagawa K, Uno M, Nakamori S, Ito T, Nagasawa N, et al. Diagnostic accuracy of endocardial-to-epicardial myocardial blood flow ratio for the detection of significant coronary artery disease with dynamic myocardial perfusion dual-source computed tomography. Circ J. 2017;81:1477–83. https://doi.org/10.1253/circj.CJ-16-1319.CrossRefPubMed

23.

Ziadi MC, Dekemp RA, Williams K, Guo A, Renaud JM, Chow BJ, et al. Does quantification of myocardial flow reserve using rubidium-82 positron emission tomography facilitate detection of multivessel coronary artery disease? J Nucl Cardiol. 2012;19:670–80. https://doi.org/10.1007/s12350-011-9506-5.CrossRefPubMed

24.

Alessio AM, Bindschadler M, Busey JM, Shuman WP, Caldwell JH, Branch KR. Accuracy of myocardial blood flow estimation from dynamic contrast-enhanced cardiac CT compared with PET. Circ Cardiovasc Imaging. 2019;12:e008323. https://doi.org/10.1161/CIRCIMAGING.118.008323.CrossRefPubMedPubMedCentral

25.

Javadi MS, Lautamäki R, Merrill J, Voicu C, Epley W, McBride G, et al. Definition of vascular territories on myocardial perfusion images by integration with true coronary anatomy: a hybrid PET/CT analysis. J Nucl Med. 2010;51:198–203. https://doi.org/10.2967/jnumed.109.067488.CrossRefPubMed

26.

Ortiz-Pérez JT, Rodríguez J, Meyers SN, Lee DC, Davidson C, Wu E. Correspondence between the 17-segment model and coronary arterial anatomy using contrast-enhanced cardiac magnetic resonance imaging. JACC Cardiovasc Imaging. 2008;1:282–93. https://doi.org/10.1016/j.jcmg.2008.01.014.CrossRefPubMed

27.

Oda S, Yoshimura A, Honda K, Iyama Y, Katahira K, Nakaura T, et al. CT angiography in patients with peripheral arterial disease: effect of small focal spot imaging and iterative model reconstruction on the image quality. Acad Radiol. 2016;23:1283–9. https://doi.org/10.1016/j.acra.2016.05.011.CrossRefPubMed

28.

Tanabe Y, Kido T, Kurata A, Kouchi T, Hosokawa T, Nishiyama H, et al. Impact of knowledge-based iterative model reconstruction on image quality and hemodynamic parameters in dynamic myocardial computed tomography perfusion using low-tube-voltage scan: a feasibility study. J Comput Assist Tomogr. 2019. https://doi.org/10.1097/RCT.0000000000000914.CrossRefPubMed

29.

Yokoi T, Tanabe Y, Kido T, Kurata A, Kido T, Uetani T, et al. Impact of the sampling rate of dynamic myocardial computed tomography perfusion on the quantitative assessment of myocardial blood flow. Clin Imaging. 2019;56:93–101. https://doi.org/10.1016/j.clinimag.2019.03.016.CrossRefPubMed

Title: Coronary artery stenosis-related perfusion ratio using dynamic computed tomography myocardial perfusion imaging: a pilot for identification of hemodynamically significant coronary artery disease
Authors: Natsumi Kuwahara
Yuki Tanabe
Teruhito Kido
Akira Kurata
Teruyoshi Uetani
Hitomi Ochi
Naoto Kawaguchi
Tomoyuki Kido
Shuntaro Ikeda
Osamu Yamaguchi
Migiwa Asano
Teruhito Mochizuki
Publication date: 01-10-2020
Publisher: Springer Japan
Keywords: Computed Tomography
Computed Tomography
CT Angiography
Arterial Diseases
Published in: Cardiovascular Intervention and Therapeutics / Issue 4/2020
Print ISSN: 1868-4300
Electronic ISSN: 1868-4297
DOI: https://doi.org/10.1007/s12928-019-00627-4

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Coronary artery stenosis-related perfusion ratio using dynamic computed tomography myocardial perfusion imaging: a pilot for identification of hemodynamically significant coronary artery disease

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2020

Acute aortic regurgitation after post-dilatation: first case of crashed leaflet in transcatheter aortic valve implantation

A case of effort angina complicated with cerebrotendinous xanthomatosis involving severe coronary artery calcification and the detection of a calcified nodule on optical coherence tomography

A novel method for prevention of intravascular ultrasound catheter entrapment using soft guide extension catheter

Comparison of diagnostic performance in assessing the rewiring position into a jailed side branch between online 3D reconstruction systems version 1.1 and 1.2 derived from optical frequency domain imaging

Effects of high-speed rotational atherectomy in peripheral artery disease patients with calcified lesions: a retrospective multicenter registry

Operators’ radiation exposure reduction during cardiac catheterization using a removable shield

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page