Author + information
- Received March 8, 2018
- Revision received May 21, 2018
- Accepted May 24, 2018
- Published online July 1, 2019.
- Satoshi Nakamura, MDa,
- Kakuya Kitagawa, MDa,∗ (, )
- Yoshitaka Goto, MDa,
- Taku Omori, MDb,
- Tairo Kurita, MDb,
- Akimasa Yamada, MDa,
- Masafumi Takafuji, MDa,
- Mio Uno, MDa,
- Kaoru Dohi, MDb and
- Hajime Sakuma, MDa
- aDepartment of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
- bDepartment of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
- ↵∗Address for correspondence:
Dr. Kakuya Kitagawa, Department of Radiology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
Objectives This study aimed to evaluate whether myocardial blood flow (MBF) quantified with dynamic computed tomography perfusion imaging (CTP) has an incremental prognostic value over coronary CT angiography (CTA) for major adverse cardiac events (MACEs) in patients with suspected coronary artery disease (CAD).
Background The incremental prognostic value of CTP over CTA is unclear. The quantification of MBF with dynamic CTP may potentially enhance risk stratification.
Methods A total of 332 patients (67% men; age: 67 ± 10 years) with suspected CAD who underwent CTA and dynamic CTP was analyzed. A MACE was defined as cardiac death, nonfatal myocardial infarction (MI), unstable angina, or hospitalization for congestive heart failure. A summed stress score (SSS) was calculated by adding scores of all myocardial segments according to normalized MBF values. Abnormal perfusion was defined as SSS ≥4. Obstructive CAD was defined as ≥50% stenosis in ≥1 vessel on CTA.
Results During a median follow-up of 2.5 years, 19 patients had a MACE. Multivariate analysis showed that, when adjusted for obstructive CAD on CTA, abnormal perfusion was significantly associated with hazards for MACEs (hazard ratio [HR]: 5.7; 95% confidence interval [CI]: 1.9 to 16.9; p = 0.002), with a significant improvement in the prognostic value. Abnormal perfusion was an independent predictor even when adjusted for ≥70% stenosis in ≥1 vessel (HR: 5.4; 95% CI: 1.7 to 16.7; p = 0.003) or adjusted for ≥50% stenosis in ≥2 vessels (HR: 6.5; 95% CI: 2.2 to 18.9; p = 0.001). In the setting of obstructive CAD, annualized event rates showed a significant difference between the patients with and without abnormal perfusion for all events (12.2% vs. 1.5%; p = 0.002) and for cardiac death and nonfatal MI (4.2% vs. 0%; p = 0.015).
Conclusions MBF quantified with dynamic CTP has an incremental prognostic value over CTA. The addition of dynamic CTP to CTA allows improved risk stratification of patients with CTA-detected stenosis.
This study was partly supported by research grants from Siemens Japan. Dr. Dohi has received speaker honoraria from Otsuka Pharmaceutical Co., Ltd. Dr. Sakuma has received research grants from Daiichi Sankyo Company, Ltd., Fuji Pharma Co., Ltd., Fujifilm RI Pharma Co., Ltd., and Eisai Co., Ltd. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 8, 2018.
- Revision received May 21, 2018.
- Accepted May 24, 2018.
- 2019 American College of Cardiology Foundation
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