2018 JACC CI (Static CTP accuracy)

OBJECTIVES The goal of this study was to evaluate the diagnostic accuracy of stress computed tomography myocardial perfusion (CTP) for the detection of functionally significant coronary artery disease (CAD) by using invasive coronary angiography (ICA) plus invasive fractional flow reserve (FFR) as the reference standard in consecutive intermediate- to high-risk symptomatic patients. BACKGROUND Stress CTP recently emerged as a potential strategy to combine the anatomic and functional evaluation of CAD in a single scan. METHODS A total of 100 consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest coronary computed tomography angiography (CTA) followed by stress static CTP with a whole-heart coverage CT scanner (Revolution CT, GE Healthcare, Milwaukee, Wisconsin). Diagnostic accuracy and overall effective dose were assessed and compared versus those of ICA and invasive FFR. RESULTS The prevalence of obstructive CAD and functionally significant CAD were 69% and 44%, respectively. Coronary CTA alone demonstrated a per-vessel and per-patient sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 98%, 76%, 99%, 63%, and 83% and of 98%, 54%, 96%, 68%, and 76%, respectively. Combining coronary CTA with stress CTP, per-vessel and per-patient sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 91%, 94%, 96%, 86%, and 93% and 98%, 83%, 98%, 86%, and 91%, with a significant improvement in specificity, positive predictive value, and accuracy in both models. The mean effective dose for coronary CTA and stress CTP were 2.8
1.4 mSv and 2.5
1.1 mSv. CONCLUSIONS The inclusion of stress CTP for the evaluation of patients with an intermediate to high risk for CAD is feasible and improved the diagnostic performance of coronary CTA for detecting functionally significant CAD.

研究目的：本研究旨在以有创冠状动脉造影（invasive coronary angiography, ICA）联合有创血流储备分数（invasive fractional flow reserve, FFR）作为参考标准，评估负荷计算机断层扫描心肌灌注（stress computed tomography myocardial perfusion, CTP）检测具有功能学意义的冠状动脉粥样硬化性心脏病（coronary artery disease, CAD）的诊断准确性，研究对象为连续纳入的中至高风险症状性患者。

研究背景：负荷CTP近年来逐渐成为一种可在单次扫描中同时完成冠状动脉解剖与功能评估的潜在诊疗策略。

研究方法：本研究前瞻性纳入100例拟行有创冠状动脉造影的连续症状性患者。所有受试者均先接受静息态冠状动脉计算机断层扫描血管造影（coronary computed tomography angiography, CTA），随后使用全心覆盖型CT扫描仪（Revolution CT，通用电气医疗集团，威斯康星州密尔沃基）行负荷静态CTP检查。评估并对比冠状动脉CTA联合负荷CTP与ICA+有创FFR的诊断效能及总有效辐射剂量。

研究结果：梗阻性冠状动脉疾病与具有功能学意义的冠状动脉疾病的患病率分别为69%与44%。仅使用冠状动脉CTA时，按血管层面与患者层面计算的敏感性、特异性、阴性预测值、阳性预测值及准确率分别为98%、76%、99%、63%、83%与98%、54%、96%、68%、76%。联合冠状动脉CTA与负荷CTP后，血管层面与患者层面的敏感性、特异性、阴性预测值、阳性预测值及准确率分别为91%、94%、96%、86%、93%与98%、83%、98%、86%、91%，两种分析模型的特异性、阳性预测值及准确率均得到显著提升。冠状动脉CTA与负荷CTP的平均有效辐射剂量分别为2.8±1.4 mSv与2.5±1.1 mSv。

研究结论：针对冠状动脉疾病中至高风险的症状性患者，加用负荷CTP进行评估具有可行性，且可提升冠状动脉CTA检测具有功能学意义的冠状动脉疾病的诊断性能。

搜集汇总

背景与挑战

背景概述

该数据集是一项2019年发布的心脏病学研究，专注于评估应力计算机断层扫描心肌灌注（CTP）在检测功能显著冠状动脉疾病中的诊断准确性。研究基于100名中高风险症状患者的前瞻性数据，通过结合冠状动脉CTA和应力CTP，显著提高了诊断特异性、阳性预测值和准确性，为临床评估提供有效工具。数据集包含相关数据文件，适用于心脏病学领域的研究和分析。