Relative Myocardial Blood Flow by Dynamic Computed Tomographic Perfusion Imaging Predicts Hemodynamic Significance of Coronary Stenosis Better Than Absolute Blood Flow

Atsushi Kono, Adriaan Coenen, Marisa Lubbers, Akira Kurata, Alexia Rossi, Anoeshka Dharampal, Marcel Dijkshoorn, Robert Jan van Geuns, Gabriel Krestin, Koen Nieman

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Abstract

Objectives: Quantitative myocardial perfusion imaging by computed tomography (CT) was recently introduced to calculate myocardial blood flow (MBF). Because absolute MBF thresholds may be affected by technique, methodology, and the microvasculature, we investigated whether a relative measure of MBF improves accuracy to identify hemodynamically significant coronary stenosis. Materials and Methods: In this prospective study, 42 patients (mean [SD] age, 62.3[8.7] years; 8 women) with suspected or known coronary disease underwent dynamic CT myocardial perfusion imaging using adenosine vasodilation, before invasive angiography (coronary angiography) with fractional flow reserve (FFR). Within each myocardial territory MBF, the MBF relative to remote myocardium (MBFratio) was calculated and compared with coronary angiography and FFR. Results: Of the 91 vessels interrogated by FFR (median, 0.81; interquartile range, 0.73-0.94), 45 vessels (49%) had an FFR value lower than 0.8 and were considered hemodynamically significant. Hyperemic MBF was lower in ischemic territories: 75.6 +/- 22.5 mL per 100 mL/min versus 98.3 +/- 23.1 mL per 100 mL/min (P < 0.0001). The MBFratio correlated better with FFR (P = 0.76) than the absolute MBF did (P = 0.52). Receiver operating curve analysis showed better discrimination by MBFratio: area under the curve of 0.85 versus 0.75 (P = 0.02). The MBF of remote myocardium varied between 60.7 and 167.2 mL per 100 mL/min and was lower in patients without heart rate acceleration (P = 0.0035). Conclusions: The MBFratio seems to better identify hemodynamically significant coronary artery disease than does the absolute MBF determined by dynamic CT perfusion imaging. This may be caused by microvascular status or related to the methodology.
Original languageUndefined/Unknown
Pages (from-to)801-807
Number of pages7
JournalInvestigative Radiology
Volume49
Issue number12
Publication statusPublished - 2014

Research programs

  • EMC COEUR-09
  • EMC NIHES-03-30-01

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