Abstract Background Dynamic coronary computed tomography perfusion (CTP) imaging during pharmacological stress is an emerging non-invasive modality that allows simultaneous assessment of coronary artery anatomy and myocardial perfusion. It holds promises for identifying hemodynamically significant coronary artery disease (CAD) and guiding the need for invasive procedures. However, the predictive value of stress CTP findings for invasive coronary angiography results and subsequent percutaneous coronary intervention (PCI) remains to be fully clarified. Purpose This study aimed to evaluate the predictive value of stress dynamic CTP findings for identifying significant CAD at ICA and the subsequent need for PCI. Methods We retrospectively analyzed data from patients referred to our institution for stress CTP for various clinical indications. All patients underwent pharmacological stress using 400 μg of regadenoson. Both qualitative and quantitative CTP parameters were assessed, including myocardial perfusion defects, severity of coronary stenosis, and plaque characteristics. A myocardial blood flow (MBF) value 110 ml/100 ml/min was considered indicative of significant hypoperfusion. Based on anatomical and functional results, patients were referred for invasive coronary angiography. Results A total of 104 patients were included in the final analysis. In the Table, main clinical differences are provided between patients who presented a significant lower myocardial blood flow in at least one segment of the left ventricle. The Upset plot in Figure A reports the distribution of symptoms which have led patients referring to perform dynamic CTP. On the other hand Figure B reports the percentage of pathological MBF according to different left ventricle segments among patients presenting impaired myocardial perfusion. Among subjects with available coronary angiography (n=24), both perfusion evaluation and stress results showed elevated specificity (83.3%) in performing PCI at cost of low sensibility, mainly due to higher prevalence of impaired MBF found at the basal posterior interventricular septum. Conclusion Dynamic stress CTP is a promising diagnostic tool for assessing functionally significant CAD. Various symptoms featured the cohort of patients referred to diagnostic evaluation, revealing a prominent cardiovascular risk profile. Despite elevated specificity, some limitations are still present, in detecting perfusion defects in certain myocardial regions, warranting further investigation and protocol refinement. Figure A and Figure B
Nardin et al. (Thu,) studied this question.