Transluminal attenuation gradient derived from coronary CT angiography to predict ischemia in SPECT myocardial perfusion imaging: Effect of coronary cross-sectional area.
Coronary artery disease
computed tomography angiography
single-photon emission computed tomography
Journal
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
ISSN: 1532-6551
Titre abrégé: J Nucl Cardiol
Pays: United States
ID NLM: 9423534
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
16
02
2020
accepted:
08
06
2020
pubmed:
3
7
2020
medline:
30
4
2022
entrez:
3
7
2020
Statut:
ppublish
Résumé
Coronary computed tomography angiography (CCTA)-based transluminal attenuation gradient (TAG) was suggested to determine the functional significance of a stenosis. However, evidence that TAG acquired by wide-volume scanners can assess the hemodynamic significance of stenosis assessed by single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is lacking. Moreover, coronary cross-sectional area may influence TAG. Hence, we aimed at assessing the diagnostic value of TAG to predict ischemia in SPECT-MPI and the correlation between TAG and the transluminal cross-sectional area gradient (TCG). Patients undergoing CCTA and SPECT-MPI for suspected coronary artery disease were included. TAG and TCG were calculated measuring the mean vessel attenuation and the cross-sectional area along major coronary vessels at 5-mm intervals. A total of 255 coronary arteries of 87 patients were included. TAG and TCG did not discriminate between coronary arteries with or without ischemia as assessed by SPECT-MPI (p = .44 and p = .25, respectively). The area under the curve to predict ischemia was not increased by adding TAG (0.88, 95% CI 0.83-0.92) or TCG (0.87, 95% CI 0.81-0.90) to CCTA alone (0.85, 95% CI 0.80-0.89). There was a significant correlation between TAG and TCG (r = 0.43; p < .001). CCTA-derived TAG and TCG do not offer any value in predicting ischemia assessed by SPECT-MPI. TAG is partly affected by differences in the coronary luminal area.
Sections du résumé
BACKGROUND
BACKGROUND
Coronary computed tomography angiography (CCTA)-based transluminal attenuation gradient (TAG) was suggested to determine the functional significance of a stenosis. However, evidence that TAG acquired by wide-volume scanners can assess the hemodynamic significance of stenosis assessed by single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is lacking. Moreover, coronary cross-sectional area may influence TAG. Hence, we aimed at assessing the diagnostic value of TAG to predict ischemia in SPECT-MPI and the correlation between TAG and the transluminal cross-sectional area gradient (TCG).
METHODS
METHODS
Patients undergoing CCTA and SPECT-MPI for suspected coronary artery disease were included. TAG and TCG were calculated measuring the mean vessel attenuation and the cross-sectional area along major coronary vessels at 5-mm intervals.
RESULTS
RESULTS
A total of 255 coronary arteries of 87 patients were included. TAG and TCG did not discriminate between coronary arteries with or without ischemia as assessed by SPECT-MPI (p = .44 and p = .25, respectively). The area under the curve to predict ischemia was not increased by adding TAG (0.88, 95% CI 0.83-0.92) or TCG (0.87, 95% CI 0.81-0.90) to CCTA alone (0.85, 95% CI 0.80-0.89). There was a significant correlation between TAG and TCG (r = 0.43; p < .001).
CONCLUSIONS
CONCLUSIONS
CCTA-derived TAG and TCG do not offer any value in predicting ischemia assessed by SPECT-MPI. TAG is partly affected by differences in the coronary luminal area.
Identifiants
pubmed: 32613474
doi: 10.1007/s12350-020-02242-w
pii: 10.1007/s12350-020-02242-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
350-358Informations de copyright
© 2020. American Society of Nuclear Cardiology.
Références
Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: Results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 2008;52:1724–32.
doi: 10.1016/j.jacc.2008.07.031
Danad I, Raijmakers PG, Driessen RS, Leipsic J, Raju R, Naoum C, et al. Comparison of coronary CT angiography, SPECT, PET, and hybrid imaging for diagnosis of ischemic heart disease determined by fractional flow reserve. JAMA Cardiol 2017;2:1100–7.
doi: 10.1001/jamacardio.2017.2471
De Bruyne B, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 2012;367:991–1001.
doi: 10.1056/NEJMoa1205361
De Bruyne B, Fearon WF, Pijls NH, Barbato E, Tonino P, Piroth Z, et al. Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med 2014;371:1208–17.
doi: 10.1056/NEJMoa1408758
Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’ t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009;360:213-24.
Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The task force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J 2019;41:407–77.
doi: 10.1093/eurheartj/ehz425
Benz DC, Gaemperli L, Gräni C, von Felten E, Giannopoulos AA, Messerli M, et al. Impact of cardiac hybrid imaging-guided patient management on clinical long-term outcome. Int J Cardiol 2018;261:218–22.
doi: 10.1016/j.ijcard.2018.01.118
Pazhenkottil AP, Benz DC, Gräni C, Madsen MA, Mikulicic F, von Felten E, et al.Hybrid SPECT perfusion imaging and coronary CT angiography: Long-term prognostic value for cardiovascular outcomes. Radiology 2018;288:694–702.
doi: 10.1148/radiol.2018171303
Douglas PS, Pontone G, Hlatky MA, Patel MR, Norgaard BL, Byrne RA, et al. Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFR(CT): outcome and resource impacts study. Eur Heart J 2015;36:3359-67.
Koo BK, Erglis A, Doh JH, Daniels DV, Jegere S, Kim HS, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol 2011;58:1989-97.
Choi JH, Min JK, Labounty TM, Lin FY, Mendoza DD, Shin DH, et al. Intracoronary transluminal attenuation gradient in coronary CT angiography for determining coronary artery stenosis. JACC Cardiovasc Imaging 2011;4:1149–57.
doi: 10.1016/j.jcmg.2011.09.006
Wong DT, Ko BS, Cameron JD, Nerlekar N, Leung MC, Malaiapan Y, et al. Transluminal attenuation gradient in coronary computed tomography angiography is a novel noninvasive approach to the identification of functionally significant coronary artery stenosis: A comparison with fractional flow reserve. J Am Coll Cardiol 2013;61:1271–9.
doi: 10.1016/j.jacc.2012.12.029
Wong DT, Ko BS, Cameron JD, Leong DP, Leung MC, Malaiapan Y, et al. Comparison of diagnostic accuracy of combined assessment using adenosine stress computed tomography perfusion + computed tomography angiography with transluminal attenuation gradient + computed tomography angiography against invasive fractional flow reserve. J Am Coll Cardiol 2014;63:1904–12.
doi: 10.1016/j.jacc.2014.02.557
Stuijfzand WJ, Danad I, Raijmakers PG, Marcu CB, Heymans MW, van Kuijk CC, et al. Additional value of transluminal attenuation gradient in CT angiography to predict hemodynamic significance of coronary artery stenosis. JACC Cardiovasc Imaging 2014;7:374–86.
doi: 10.1016/j.jcmg.2013.12.013
Bom MJ, Driessen RS, Stuijfzand WJ, Raijmakers PG, Van Kuijk CC, Lammertsma AA, et al. Diagnostic value of transluminal attenuation gradient for the presence of ischemia as defined by fractional flow reserve and quantitative positron emission tomography. JACC Cardiovasc Imaging 2019;12:323–33.
doi: 10.1016/j.jcmg.2017.10.009
Steigner ML, Mitsouras D, Whitmore AG, Otero HJ, Wang C, Buckley O, et al. Iodinated contrast opacification gradients in normal coronary arteries imaged with prospectively ECG-gated single heart beat 320-detector row computed tomography. Circ Cardiovasc imaging 2010;3:179–86.
doi: 10.1161/CIRCIMAGING.109.854307
Bae YG, Hwang ST, Han H, Kim SM, Kim HY, Park I, et al. Non-invasive coronary physiology based on computational analysis of intracoronary transluminal attenuation gradient. Sci Rep 2018;8:4692.
doi: 10.1038/s41598-018-23134-7
Lardo AC, Rahsepar AA, Seo JH, Eslami P, Korley F, Kishi S, et al. Estimating coronary blood flow using CT transluminal attenuation flow encoding: Formulation, preclinical validation, and clinical feasibility. J Cardiovasc Comput Tomogr 2015;9:559-66 e1.
Funama Y, Utsunomiya D, Oda S, Shimonobo T, Nakaura T, Mukunoki T, et al. Transluminal attenuation-gradient coronary CT angiography on a 320-MDCT volume scanner: Effect of scan timing, coronary artery stenosis, and cardiac output using a contrast medium flow phantom. Phys Med 2016;32:1415–21.
doi: 10.1016/j.ejmp.2016.10.011
Park EA, Lee W, Park SJ, Kim YK, Hwang HY. Influence of coronary artery diameter on intracoronary transluminal attenuation gradient during CT angiography. JACC Cardiovasc Imaging 2016;9:1074–83.
doi: 10.1016/j.jcmg.2015.10.028
Benz DC, Gräni C, Hirt Moch B, Mikulicic F, Vontobel J, Fuchs TA, et al. Minimized radiation and contrast agent exposure for coronary computed tomography angiography: First clinical experience on a latest generation 256-slice scanner. Acad Radiol 2016;23:1008–14.
doi: 10.1016/j.acra.2016.03.015
Husmann L, Valenta I, Gaemperli O, Adda O, Treyer V, Wyss CA, et al. Feasibility of low-dose coronary CT angiography: First experience with prospective ECG-gating. Eur Heart J 2008;29:191–7.
doi: 10.1093/eurheartj/ehm613
Benz DC, Grani C, Hirt Moch B, Mikulicic F, Vontobel J, Fuchs TA, et al. A low-dose and an ultra-low-dose contrast agent protocol for coronary CT angiography in a clinical setting: Quantitative and qualitative comparison to a standard dose protocol. Br J Radiol 2017;90:20160933.
doi: 10.1259/bjr.20160933
Benz DC, Grani C, Ferro P, Neumeier L, Messerli M, Possner M, et al. Corrected coronary opacification decrease from coronary computed tomography angiography: Validation with quantitative 13N-ammonia positron emission tomography. J Nucl Cardiol 2019;26:561–8.
doi: 10.1007/s12350-017-0980-2
Verberne HJ, Acampa W, Anagnostopoulos C, Ballinger J, Bengel F, De Bondt P et al. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging 2015;42;1929-40.
doi: 10.1007/s00259-015-3139-x
Grossmann M, Giannopoulos AA, Bechtiger FA, Messerli M, Schwyzer M, Benz DC et al. Ultra-low-dose computed tomography for attenuation correction of cadmium-zinc-telluride single photon emission computed tomography myocardial perfusion imaging. J Nucl Cardiol 2020;27:228–37.
doi: 10.1007/s12350-018-1303-y
Herzog BA, Buechel RR, Katz R, Brueckner M, Husmann L, Burger IA, et al. Nuclear myocardial perfusion imaging with a cadmium-zinc-telluride detector technique: Optimized protocol for scan time reduction. J Nucl Med 2010;51:46–51.
doi: 10.2967/jnumed.109.065532
Buechel RR, Herzog BA, Husmann L, Burger IA, Pazhenkottil AP, Treyer V, et al. Ultrafast nuclear myocardial perfusion imaging on a new gamma camera with semiconductor detector technique: First clinical validation. Eur J Nucl Med Mol Imaging 2010;37:773–8.
doi: 10.1007/s00259-009-1375-7
Choi J-H, Min JK, Labounty TM, Lin FY, Mendoza DD, Shin DH, et al. Intracoronary transluminal attenuation gradient in coronary CT angiography for determining coronary artery stenosis. JACC 2011;4:1149-57.
Benz DC, Mikulicic F, Gräni C, Moret D, Possner M, Clerc OF, et al. Long-term outcome prediction by functional parameters derived from coronary computed tomography angiography. Int J Cardiol 2017;243:533–7.
doi: 10.1016/j.ijcard.2017.05.083
Benz DC, Mikulicic F, Grani C, Grossmann M, Giannopoulos AA, Messerli M, et al. Diagnostic accuracy of coronary opacification derived from coronary computed tomography angiography to detect ischemia: First validation versus single-photon emission computed tomography. EJNMMI Res 2017;7:92.
doi: 10.1186/s13550-017-0342-8
Choi J-H, Koo B-K, Yoon YE, Min JK, Song Y-B, Hahn J-Y, et al. Diagnostic performance of intracoronary gradient-based methods by coronary computed tomography angiography for the evaluation of physiologically significant coronary artery stenoses: a validation study with fractional flow reserve. Eur Heart J 2012;13:1001–7.
Fujimoto S, Giannopoulos AA, Kumamaru KK, Matsumori R, Tang A, Kato E, et al. The transluminal attenuation gradient in coronary CT angiography for the detection of hemodynamically significant disease: can all arteries be treated equally? Br J Radiol 2018;91:20180043.
doi: 10.1259/bjr.20180043