Stress Computed Tomographic Perfusion
Are We Ready for the Green Light?
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Noninvasive stress tests are commonly used as gatekeepers to invasive coronary angiography (ICA). However, an analysis from the National Cardiovascular Data Registry noted the low diagnostic yield of elective ICA.1 Coronary computed tomographic angiography (cCTA) was introduced as an excellent alternative imaging modality to rule out coronary artery disease (CAD) with low radiation exposure2 and improve prognostic assessment.3 Recent data demonstrated equivalent to improved clinical outcomes with a cCTA-guided diagnostic strategy compared with noninvasive stress tests.4 However, cCTA, particularly in the presence of calcified coronary lesions, overestimates CAD,5 resulting in further testing with increased ionizing radiation exposure, additional costs, and overtreatment of CAD.6 In this regard, new cCTA techniques such as stress computed tomographic perfusion (stress-CTP) have emerged as potential strategies to combine anatomic and functional evaluation in single scan. Recently, Yang et al7 demonstrated that stress-CTP had similar area under the curve (AUC; 0.91 versus 0.95 and 0.88 versus 0.93 per-patient and per-vessel level, respectively) as compared with cardiac magnetic resonance with a trend for better performance when compared with single photon emission computed tomography AUC (0.91 versus 0.87). When compared with invasive fractional flow reserve (FFR) as the reference standard, the sensitivity and specificity of stress-CTP in detecting flow-limiting coronary stenosis were 88% and 80%, respectively.8 Less data are available on the prognostic value of global quantification of left ventricular myocardial perfusion with dynamic stress-CTP. Meinel et al9 recently showed that in 144 patients evaluated with dynamic stress-CTP, global myocardial blood flow (MBF) of <121 mL/100 mL/min was associated with an increased risk for major adverse cardiovascular events (hazard ratio, 2.07; 95% confidence interval,1.12–3.84; P=0.02). The association remained significant after adjusting for age, sex, and clinical …