Abstract 21273: Usefulness of Myocardial Imaging by 64 Multidetector-row Computed Tomography Using Adenosine Triphosphate Stress Test to Assess Myocardial Ischemia and Stenotic Coronary Artery
Background: Both anatomical and physiological assessment of coronary artery disease are important. We hypothesized that contrast-enhanced 64 multidetector-row computed tomography (MDCT) with adenosine 5'-triphosphate (ATP) stress test can describe a hypoenhancement area in a myocardial ischemia part which was concordant with a coronary artery territory. Furthermore it can identify significant stenotic coronary artery including with poor quality of CT coronary angiogram (CTCA) image. This study sought to evaluate myocardial ischemia and stenotic coronary artery using contrast-enhanced 64-MDCT with ATP stress.
Methods and Results: We performed ATP stress 64-MDCT and conventional coronary angiogram (CCA) in 40 patients. Poor image quality of CTCA was recognized in 28 vessels. By CCA analysis, 20 vessels in 15 patients were detected to have stenotic arteries. Subendocardium CT values in ischemic segments were significantly lower than those in non-ischemic segments at both diastolic and systolic phases (105 ± 20 versus 117 ± 19 HU; P <0.001 and 91 ± 21 versus 113 ± 19 HU, P <0.001, respectively). Sensitivity, specificity, and positive and negative predictive value of CT myocardium image analysis to identify significant coronary stenosis were 80%, 98%, 84%, and 97%, respectively. Fractional flow reserve (FFR) was measured for 14 moderate stenotic coronary arteries. FFR values in the stenotic artery were significantly lower than in non-stenotic artery by CT myocardium image analysis (0.67 ± 0.11 versus 0.87 ± 0.03, P <0.01).
Conclusion: ATP-stressed contrast-enhanced 64-MDCT can evaluate myocardial ischemia and stenotic coronary artery including in cases with difficulty in assessment by CTCA.
- © 2010 by American Heart Association, Inc.