Prognostic value of CT myocardial perfusion imaging and CT-derived fractional flow reserve for major adverse cardiac events in patients with coronary artery disease

• Published in: Journal of cardiovascular computed tomography 2019-05, Vol.13 (3), p.26-33
• Main Authors: van Assen, M., De Cecco, C.N., Eid, M., von Knebel Doeberitz, P., Scarabello, M., Lavra, F., Bauer, M.J., Mastrodicasa, D., Duguay, T.M., Zaki, B., Lo, G.G., Choe, Y.H., Wang, Y., Sahbaee, Pooyan, Tesche, Christian, Oudkerk, M., Vliegenthart, R., Schoepf, U.J.
• Format: Article
• Language: English
• Subjects: Aged; Artificial Intelligence; Asia; Computed Tomography Angiography - methods; Coronary Angiography - methods; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Europe; Female; Fractional flow reserve; Fractional Flow Reserve, Myocardial; Humans; Male; Middle Aged; Myocardial ischemia; Myocardial Perfusion Imaging - methods; Perfusion imaging; Predictive Value of Tests; Prognosis; Prospective Studies; Radiographic Image Interpretation, Computer-Assisted; Registries; Risk Assessment; Risk Factors; United States
• ISSN: 1934-5925; 1876-861X
• DOI: 10.1016/j.jcct.2019.02.005

The purpose of this study was to analyze the prognostic value of dynamic CT perfusion imaging (CTP) and CT derived fractional flow reserve (CT-FFR) for major adverse cardiac events (MACE). 81 patients from 4 institutions underwent coronary computed tomography angiography (CCTA) with dynamic CTP imaging and CT-FFR analysis. Patients were followed-up at 6, 12, and 18 months after imaging. MACE were defined as cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, or revascularization. CT-FFR was computed for each major coronary artery using an artificial intelligence-based application. CTP studies were analyzed per vessel territory using an index myocardial blood flow, the ratio between territory and global MBF. The prognostic value of CCTA, CT-FFR, and CTP was investigated with a univariate and multivariate Cox proportional hazards regression model. 243 vessels in 81 patients were interrogated by CCTA with CT-FFR and 243 vessel territories (1296 segments) were evaluated with dynamic CTP imaging. Of the 81 patients, 25 (31%) experienced MACE during follow-up. In univariate analysis, a positive index-MBF resulted in the largest risk for MACE (HR 11.4) compared to CCTA (HR 2.6) and CT-FFR (HR 4.6). In multivariate analysis, including clinical factors, CCTA, CT-FFR, and index-MBF, only index-MBF significantly contributed to the risk of MACE (HR 10.1), unlike CCTA (HR 1.2) and CT-FFR (HR 2.2). Our study provides initial evidence that dynamic CTP alone has the highest prognostic value for MACE compared to CCTA and CT-FFR individually or a combination of the three, independent of clinical risk factors. This study evaluated the prognostic value of CCTA, CT-FFR, and dynamic CTP imaging for MACE. A total of 243 vessels and territories were analyzed in 81 patients. Our results demonstrate that index-MBF calculated from dynamic CTP acquisitions has the highest prognostic value, over CCTA and CT-FFR values. In univariate analysis, a positive index-MBF resulted in the largest risk for MACE (HR 11.4), compared to CCTA (HR 2.6) and CT-FFR (HR 4.6). In multivariate analysis, only index-MBF significantly contributed to the risk of MACE (HR 10.1), unlike CCTA (HR 1.2) and CT-FFR (HR 2.2).