Author + information
- Received July 3, 2019
- Revision received December 12, 2019
- Accepted December 20, 2019
- Published online August 3, 2020.
- Satoshi Nakamura, MDa,
- Kakuya Kitagawa, MDb,∗ (, )
- Yoshitaka Goto, MDa,
- Masafumi Takafuji, MDa,
- Shiro Nakamori, MDc,
- Tairo Kurita, MDc,
- Kaoru Dohi, MDc and
- Hajime Sakuma, MDa
- aDepartment of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
- bDepartment of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan
- cDepartment 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 sought to evaluate the prognostic value of stress dynamic computed tomography (CT) perfusion (CTP) with CT delayed enhancement (CTDE) in patients with suspected or known coronary artery disease (CAD) and in subgroups of patients with stent, heavy calcification, or stenosis.
Background The prognostic value of stress dynamic CTP with CTDE is unknown.
Methods Participants were 540 patients with suspected or known CAD. Major adverse cardiac event(s) (MACE) consisted of cardiac death, nonfatal myocardial infarction, unstable angina, or hospitalization for congestive heart failure. Ischemic score was calculated by scoring the reduction of normalized myocardial blood flow in 16 segments excluding areas of myocardial scarring. Ischemic perfusion defect (IPD) was defined as Ischemic score ≥4. Scar score was also calculated by scoring the transmural extent of scarring in each segment on CTDE.
Results During a median follow-up of 2.9 years, 43 MACEs occurred. By adding IPD to obstructive CAD (≥50% stenosis) on coronary CT angiography, the concordance index for predicting MACEs increased from 0.73 to 0.82 in patients with suspected CAD (p = 0.028) and from 0.61 to 0.73 in patients with known CAD (p = 0.004). IPD and scar score of ≥4 were independent predictors when adjusted for each other in patients with suspected (adjusted hazard ratios: 7.5 [p < 0.001] and 3.0 [p = 0.034], respectively) or known CAD (adjusted hazard ratios: 4.4 [p = 0.001] and 3.2 [p = 0.024], respectively). Patients with IPD had a higher annualized event rate than those without IPD in subgroups of those with stent (11.5% vs. 2.6%; p < 0.001), heavy calcification (13.3% vs. 3.1%; p < 0.001), 50% to 69% stenosis (8.8% vs. 1.0%; p < 0.001), or ≥70% stenosis (12.4% vs. 3.6%; p < 0.001).
Conclusions Stress dynamic CTP with CTDE had incremental prognostic value over CT angiography in each group with suspected or known CAD and was prognostically useful in subgroups of patients with stent, heavy calcification, or obstructive CAD. IPD and myocardial scarring may play complementary roles in prognostic stratification.
This study was partly supported by research grants from Siemens Japan. Dr. Dohi received speaker honoraria from Otsuka and Takeda. Dr. Sakuma has received research grants from Daiichi Sankyo, Fuji Pharma, Fujifilm RI Pharma, and Eisai. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received July 3, 2019.
- Revision received December 12, 2019.
- Accepted December 20, 2019.
- 2020 American College of Cardiology Foundation
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