Influence of Cardiac CT based disease severity and clinical symptoms on the diagnostic performance of myocardial perfusion

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  • L Nissen
  • S Winther
  • J Westra
  • J A Ejlersen
  • C Isaksen, Department of Radiology, Silkeborg Regional Hospital, Silkeborg, Denmark
  • ,
  • A Rossi, Department of Diagnostic Imaging, Humanitas Research Hospital, Milan, Italy.
  • ,
  • N R Holm
  • G Urbonaviciene
  • L C Gormsen
  • L H Madsen, Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, 7400 Herning, Denmark.
  • ,
  • E H Christiansen, Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
  • ,
  • M Maeng, Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
  • ,
  • L L Knudsen, Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, 7400 Herning, Denmark.
  • ,
  • L Frost, Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark.
  • ,
  • L Brix
  • H E Bøtker
  • S E Petersen
  • M Bøttcher

We aimed to identify factors influencing the sensitivity of perfusion imaging after an initial positive coronary computed tomography angiography (CCTA) using invasive coronary angiography (ICA) with conditional fractional flow reserve (FFR) as reference. Secondly we aimed to identify factors associated with revascularisation and to evaluate treatment outcome after ICA. We analysed 292 consecutive patients with suspected significant coronary artery disease (CAD) at CCTA, who underwent perfusion imaging with either cardiac magnetic resonance (CMR) or myocardial perfusion scintigraphy (MPS) followed by ICA with conditional FFR. Stratified analysis and uni- and multiple logistic regression analyses were performed to identify predictors of diagnostic agreement between perfusion scans and ICA and predictors of revascularisation. Myocardial ischemia evaluated with perfusion scans was present in 65/292 (22%) while 117/292 (40%) had obstructive CAD evaluated by ICA. Revascularisation rate was 90/292 (31%). The overall sensitivity for perfusion scans was 39% (30-48), specificity 89% (83-93), PPV 69% (57-80) and NPV 68% (62-74). Stratified analysis showed higher sensitivities in patients with multi-vessel disease at CCTA 49% (37-60) and typical chest pain 50% (37-60). Predictors of revascularisation were multi-vessel disease by CCTA (OR 3.51 [1.91-6.48]) and a positive perfusion scan (OR 4.69 [2.49-8.83]). The sensitivity for perfusion scans after CCTA was highest in patients with typical angina and multiple lesions at CCTA and predicted diagnostic agreement between perfusion scans and ICA. Abnormal perfusion and multi vessel disease at CCTA predicted revascularisation.

Original languageEnglish
JournalThe international journal of cardiovascular imaging
ISSN1569-5794
DOIs
Publication statusE-pub ahead of print - 23 Apr 2019

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