Incremental Diagnostic Value of Stress Computed Tomography Myocardial Perfusion With Whole-Heart Coverage CT Scanner in Intermediate- to High-Risk Symptomatic Patients Suspected of Coronary Artery Disease

Gianluca Pontone; Daniele Andreini; Andrea I. Guaricci; Andrea Baggiano; Fabio Fazzari; Marco Guglielmo; Giuseppe Muscogiuri; Claudio Maria Berzovini; Annalisa Pasquini; Saima Mushtaq; Edoardo Conte; Giuseppe Calligaris; Stefano De Martini; Cristina Ferrari; Stefano Galli; Luca Grancini; Paolo Ravagnani; Giovanni Teruzzi; Daniela Trabattoni; Franco Fabbiocchi; Alessandro Lualdi; Piero Montorsi; Mark G. Rabbat; Antonio L. Bartorelli; Mauro Pepi

doi:10.1016/j.jcmg.2017.10.025

JACC: Cardiovascular Imaging

Volume 12, Issue 2, February 2019 DOI: 10.1016/j.jcmg.2017.10.025

Incremental Diagnostic Value of Stress Computed Tomography Myocardial Perfusion With Whole-Heart Coverage CT Scanner in Intermediate- to High-Risk Symptomatic Patients Suspected of Coronary Artery Disease

Gianluca Pontone, Daniele Andreini, Andrea I. Guaricci, Andrea Baggiano, Fabio Fazzari, Marco Guglielmo, Giuseppe Muscogiuri, Claudio Maria Berzovini, Annalisa Pasquini, Saima Mushtaq, Edoardo Conte, Giuseppe Calligaris, Stefano De Martini, Cristina Ferrari, Stefano Galli, Luca Grancini, Paolo Ravagnani, Giovanni Teruzzi, Daniela Trabattoni, Franco Fabbiocchi, Alessandro Lualdi, Piero Montorsi, Mark G. Rabbat, Antonio L. Bartorelli and Mauro Pepi

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Author + information

vol. 12 no. 2 338-349

DOI:

https://doi.org/10.1016/j.jcmg.2017.10.025

Published By:

JACC: Cardiovascular Imaging

Print ISSN:

1936-878X

Online ISSN:

1876-7591

History:

Received July 19, 2017
Revision received October 18, 2017
Accepted October 19, 2017
Published online February 4, 2019.

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previous version (February 14, 2018 - 11:01).
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2019 American College of Cardiology Foundation

Author Information

Gianluca Pontone, MD, PhD^a,^∗ (gianluca.pontone{at}ccfm.it),
Daniele Andreini, MD, PhD^a,^b,
Andrea I. Guaricci, MD^c,^d,
Andrea Baggiano, MD^a,
Fabio Fazzari, MD^e,
Marco Guglielmo, MD^a,
Giuseppe Muscogiuri, MD^a,
Claudio Maria Berzovini, MD^f,
Annalisa Pasquini, MD^g,
Saima Mushtaq, MD^a,
Edoardo Conte, MD^a,
Giuseppe Calligaris, MD^a,
Stefano De Martini, MD^a,
Cristina Ferrari, MD^a,
Stefano Galli, MD^a,
Luca Grancini, MD^a,
Paolo Ravagnani, MD^a,
Giovanni Teruzzi, MD^a,
Daniela Trabattoni, MD^a,
Franco Fabbiocchi, MD^a,
Alessandro Lualdi, MD^a,
Piero Montorsi, MD^a,^b,
Mark G. Rabbat, MD^h,ⁱ,
Antonio L. Bartorelli, MD^a,^j and
Mauro Pepi, MD^a

^aCentro Cardiologico Monzino, IRCCS, Milan, Italy
^bDepartment of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
^cInstitute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital “Policlinico” of Bari, Bari, Italy
^dDepartment of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
^eDepartment of Cardiology, University Hospital P. Giaccone, Palermo, Italy
^fRadiology Institute, Department of Surgical Sciences, University of Turin, Turin, Italy
^gDepartment of Cardiology, Policlinico Umberto I,“Sapienza” University of Rome, Rome, Italy
^hLoyola University of Chicago, Chicago, Illinois
ⁱEdward Hines Jr. VA Hospital, Hines, Illinois
^jDepartment of Biomedical and Clinical Sciences “Luigi Sacco,” University of Milan, Milan, Italy

↵∗Address for correspondence:
Dr. Gianluca Pontone, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy.

Graphical abstract

Abstract

Objectives The goal of this study was to evaluate the diagnostic accuracy of stress computed tomography myocardial perfusion (CTP) for the detection of functionally significant coronary artery disease (CAD) by using invasive coronary angiography (ICA) plus invasive fractional flow reserve (FFR) as the reference standard in consecutive intermediate- to high-risk symptomatic patients.

Background Stress CTP recently emerged as a potential strategy to combine the anatomic and functional evaluation of CAD in a single scan.

Methods A total of 100 consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest coronary computed tomography angiography (CTA) followed by stress static CTP with a whole-heart coverage CT scanner (Revolution CT, GE Healthcare, Milwaukee, Wisconsin). Diagnostic accuracy and overall effective dose were assessed and compared versus those of ICA and invasive FFR.

Results The prevalence of obstructive CAD and functionally significant CAD were 69% and 44%, respectively. Coronary CTA alone demonstrated a per-vessel and per-patient sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 98%, 76%, 99%, 63%, and 83% and of 98%, 54%, 96%, 68%, and 76%, respectively. Combining coronary CTA with stress CTP, per-vessel and per-patient sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 91%, 94%, 96%, 86%, and 93% and 98%, 83%, 98%, 86%, and 91%, with a significant improvement in specificity, positive predictive value, and accuracy in both models. The mean effective dose for coronary CTA and stress CTP were 2.8 ± 1.4 mSv and 2.5 ± 1.1 mSv.

Conclusions The inclusion of stress CTP for the evaluation of patients with an intermediate to high risk for CAD is feasible and improved the diagnostic performance of coronary CTA for detecting functionally significant CAD.

Key Words

Footnotes

Dr. Pontone has received institutional fees as a speaker and clinical research grants from GE and Bracco; institutional fees as a speaker from Medtronic and Bayer; and an institutional research grant from HeartFlow. Dr. Andreini has received institutional fees as a speaker and clinical research grants from GE, Bracco, and Heartflow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Received July 19, 2017.
Revision received October 18, 2017.
Accepted October 19, 2017.

2019 American College of Cardiology Foundation

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