2018 EHJCI (Qualitative vs. Quantitative stress CTP)

Aims To compare the diagnostic accuracy of stress computed tomography myocardial perfusion (CTP) for the detection of significant coronary artery disease with visual approach vs. quantitative analysis with transmural perfusion ratio (TPR) in consecutive symptomatic patients scheduled for invasive coronary angiography (ICA) plus invasive fractional flow reserve (FFR). .................................................................................................................................................................................................. Methods and results Eighty-eight consecutive symptomatic patients underwent rest coronary computed tomography angiography (cCTA) followed by static stress-CTP. Diagnostic accuracy of cCTA þ stress-CTP with visual evaluation and with TPR measurement was calculated and compared with ICA and invasive FFR. Addition of stress-CTP with qualitative evaluation to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy at a vessel and patient level of 92%, 92%, 97%, 82%, 92% and 98%, 80%, 97%, 82%, 89%, respectively indicating a significant improvement of specificity, positive predictive value, and accuracy values vs. rest-cCTA in both models. Similarly, addition of stress-CTP with TPR evaluation to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy at a vessel and patient level of 84%, 90%, 93%, 76%, 88% and 91%, 71%, 89%, 75%, 81%, respectively indicating a significant improvement of specificity, positive predictive value values vs. rest-cCTA only in a vessel-based model and of positive predictive value in a patient-based model. When cCTA þ stress-CTP with qualitative evaluation was compared with cCTA þ stress-CTP with TPR estimation, no differences were found in terms of diagnostic performance. .................................................................................................................................................................................................. Conclusion The addition of stress-CTP with visual evaluation to cCTA imaging has similar diagnostic performance when compared with the quantitative analysis of myocardial perfusion based on TPR measurement.研究目的：旨在对比负荷心肌灌注计算机断层扫描（CTP）分别采用视觉评估法与基于跨壁灌注比（TPR）的定量分析，在计划接受有创冠状动脉造影（ICA）联合有创血流储备分数（FFR）的连续有症状患者中，检测显著冠状动脉病变的诊断准确度。 方法与结果 88例连续入组的有症状患者先后接受静息态冠状动脉计算机断层血管造影（cCTA）与静态负荷CTP检查。分别以视觉评估法、TPR定量分析法两种方式，计算cCTA联合负荷CTP的诊断准确度，并与ICA及有创FFR的检测结果进行对比。 将定性评估的负荷CTP加入静息cCTA后，在血管层面与患者层面的灵敏度、特异度、阴性预测值、阳性预测值及准确度分别为92%、92%、97%、82%、92%与98%、80%、97%、82%、89%，结果显示相较于单纯静息cCTA，两种分析模型的特异度、阳性预测值及准确度均得到显著提升。 同理，将基于TPR评估的负荷CTP加入静息cCTA后，在血管层面与患者层面的灵敏度、特异度、阴性预测值、阳性预测值及准确度分别为84%、90%、93%、76%、88%与91%、71%、89%、75%、81%，结果显示仅在血管层面模型中，其特异度、阳性预测值较单纯静息cCTA得到显著提升，而在患者层面模型中仅阳性预测值得到提升。 当对比采用定性评估的cCTA联合负荷CTP与采用TPR定量评估的cCTA联合负荷CTP时，二者的诊断效能无显著差异。 结论：相较于基于TPR测量的心肌灌注定量分析，在cCTA成像中加入视觉评估的负荷CTP，其诊断效能与之相当。