Myocardial Perfusion In Coronary Artery Disease Research Articles

Value of Dynamic Computed Tomography Myocardial Perfusion in CAD: A Systematic Review and Meta-analysis.

Dynamic stress computed tomography (CT) perfusion is a non-invasive method for quantifying myocardial ischemia by assessing myocardial blood flow (MBF). In this meta-analysis, we evaluated the diagnostic accuracy of dynamic CT perfusion for the detection of significant coronary artery disease (CAD) across various CT scanners, obese patients, and its prognostic value. We systematically searched PubMed, Embase, Web of Science, and Cochrane library for published studies evaluating the accuracy of CT myocardial perfusion in diagnosing functional significant ischemia by invasive fractional flow reserve. The diagnostic performance of dynamic CT perfusion in detecting ischemia was evaluated using a summary receiver operating characteristic (sROC) curve. A total of 23 studies underwent meta- analysis. In myocardial region without ischemia, MBF was measured at 1.44 ml/min/g (95% confidence interval [CI]: 1.13-1.75), while in region with ischemia, it was 0.94 ml/min/g (95% CI: 0.80-1.08) (p<0.001). On the patient-based analysis, the area under the sROC curve of CT-MBF was 0.93, with a sensitivity of 0.84 and specificity of 0.88. Differences in CT type (dual source vs. single source), and body mass index (BMI) did not significantly affect the diagnostic performance. The pooled hazard ratio of dynamic CT perfusion for predicting adverse events was 4.98 (95%CI: 2.08-11.93, p=<0.001, I2=61%, p for heterogeneity = 0.07). Dynamic CT perfusion has high diagnostic performance in the quantitative assessment of ischemia and detection of functional myocardial ischemia as defined by invasive FFR, and may be useful in risk stratification of CAD patients.

3 Tesla is the preferred field strength for perfusion imaging in coronary artery disease – a comparison to 1.5 Tesla and fractional flow reserve

Background Adenosine perfusion imaging at 1.5 Tesla (T) has been shown to yield good diagnostic values in comparison to quantitative coronary angiography. Perfusion imaging at 3 T has the potential benefit of higher contrast- and signalto-noise ratios. However, little is known about diagnostic performance of 3 T perfusion imaging in comparison to 1.5 T and in comparison to invasive measurement of fractional flow reserve (FFR). We sought to evaluate visual and quantitative assessment of adenosine perfusion at 3 T in comparison to 1.5 T and to coronary angiography in patients presenting with suspected coronary artery disease (CAD). Methods 86 consecutive patients with suspected CAD were enrolled in this study. All patients underwent adenosine perfusion at 3 T (Achieva, Philips Medical Systems) and 1.5 T (Intera, Philips Medical Systems) within 72 hours with subsequent coronary angiography within 72 hours. Two independent patient groups were formed. In group 1 1 (N=52) quantitative coronary analysis (QCA) was compared to qualitative perfusion MRI imaging. Group 2 (N=34) underwent FFR measurement in all three major coronary arteries in comparison to quantitative myocardial perfusion reserve (MPR). Results In both groups a significant (p<0.05) higher sensitivity and specificity (group 1: 0.88 vs 0.80 and 0.96 vs. 0.89, p<0.01; group 2 0.91 vs. 0.62 and 1.0 vs. 0.77, p<0.001) was found for 3 T when compared to 1.5 T. Conclusions 3 T appears to be the superior field strength for visual or quantitative analysis of myocardial perfusion in CAD as shown in our two consecutive patient groups.