P6190Dynamic stress CTP with a whole-heart coverage scanner in addition to cCTA and FFRCT

A Baggiano,S Mushtaq,A Formenti,M Guglielmo,M Pepi,A L Bartorelli,L Fusini,D Andreini,A Annoni,E Mancini,G Muscogiuri,G Pontone,E Conte,A Del Torto,A I Guaricci

doi:10.1093/eurheartj/ehz746.0795

Abstract

Abstract Background Recently, new techniques such as dynamic stress computed tomography perfusion (stress-CTP) emerged as potential strategies to combine anatomical and functional evaluation in a one-shot scan. However, previous experience used technology that was associated with high radiation exposure. Purpose The aim of the study is to test the diagnostic accuracy of integrated evaluation of dynamic myocardial computed tomography perfusion (CTP) on top of coronary computed tomography angiography (cCTA) plus FFR computed tomography derived (FFRCT) by using a whole-heart coverage CT scanner as compared to invasive coronary angiography (ICA) plus clinically indicate invasive fractional flow reserve (FFR). Methods Eighty-five consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest cCTA followed by stress dynamic CTP with a whole-heart coverage CT scanner. FFRCT was also measured by using the rest cCTA dataset. The diagnostic accuracy to detect functionally significant CAD in a vessel-based model of cCTA alone, cCTA+FFRCT, cCTA+CTP or cCTA+FFRCT+CTP were assessed and compared by using ICA and invasive FFR as reference. The overall effective dose of dynamic CTP was also measured. Results The prevalence of obstructive CAD and functionally significant CAD were 77% and 57%, respectively. The sensitivity and specificity of cCTA alone, cCTA+FFRCT and cCTA+CTP, were 83% and 66%, 86% and 75%, 73% and 86%, respectively. Both the addition of FFRCT and CTP improves the area under the curve (AUC: 0.876 and 0.878, respectively) as compared to cCTA alone (0.826, p<0.05). The sequential strategy of cCTA+FFRCT+CTP showed the highest AUC (0.919, p<0.05) as compared to all other strategies. The mean ED for cCTA and stress CTP was 2.8±1.2 and 5.3±0.7 mSv, respectively. Conclusions The addition of dynamic stress CTP on top of cCTA and FFRCT provides additional diagnostic accuracy with acceptable radiation exposure.

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