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Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study.


ABSTRACT: AIMS:To evaluate the diagnostic power of integrating the results of computed tomography angiography (CTA) and CT myocardial perfusion (CTP) to identify coronary artery disease (CAD) defined as a flow limiting coronary artery stenosis causing a perfusion defect by single photon emission computed tomography (SPECT). METHODS AND RESULTS:We conducted a multicentre study to evaluate the accuracy of integrated CTA-CTP for the identification of patients with flow-limiting CAD defined by ?50% stenosis by invasive coronary angiography (ICA) with a corresponding perfusion deficit on stress single photon emission computed tomography (SPECT/MPI). Sixteen centres enroled 381 patients who underwent combined CTA-CTP and SPECT/MPI prior to conventional coronary angiography. All four image modalities were analysed in blinded independent core laboratories. The prevalence of obstructive CAD defined by combined ICA-SPECT/MPI and ICA alone was 38 and 59%, respectively. The patient-based diagnostic accuracy defined by the area under the receiver operating characteristic curve (AUC) of integrated CTA-CTP for detecting or excluding flow-limiting CAD was 0.87 [95% confidence interval (CI): 0.84-0.91]. In patients without prior myocardial infarction, the AUC was 0.90 (95% CI: 0.87-0.94) and in patients without prior CAD the AUC for combined CTA-CTP was 0.93 (95% CI: 0.89-0.97). For the combination of a CTA stenosis ?50% stenosis and a CTP perfusion deficit, the sensitivity, specificity, positive predictive, and negative predicative values (95% CI) were 80% (72-86), 74% (68-80), 65% (58-72), and 86% (80-90), respectively. For flow-limiting disease defined by ICA-SPECT/MPI, the accuracy of CTA was significantly increased by the addition of CTP at both the patient and vessel levels. CONCLUSIONS:The combination of CTA and perfusion correctly identifies patients with flow limiting CAD defined as ?50 stenosis by ICA causing a perfusion defect by SPECT/MPI.

SUBMITTER: Rochitte CE 

PROVIDER: S-EPMC6693293 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

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Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study.

Rochitte Carlos E CE   George Richard T RT   Chen Marcus Y MY   Arbab-Zadeh Armin A   Dewey Marc M   Miller Julie M JM   Niinuma Hiroyuki H   Yoshioka Kunihiro K   Kitagawa Kakuya K   Nakamori Shiro S   Laham Roger R   Vavere Andrea L AL   Cerci Rodrigo J RJ   Mehra Vishal C VC   Nomura Cesar C   Kofoed Klaus F KF   Jinzaki Masahiro M   Kuribayashi Sachio S   de Roos Albert A   Laule Michael M   Tan Swee Yaw SY   Hoe John J   Paul Narinder N   Rybicki Frank J FJ   Brinker Jeffery A JA   Arai Andrew E AE   Cox Christopher C   Clouse Melvin E ME   Di Carli Marcelo F MF   Lima Joao A C JA  

European heart journal 20131119 17


<h4>Aims</h4>To evaluate the diagnostic power of integrating the results of computed tomography angiography (CTA) and CT myocardial perfusion (CTP) to identify coronary artery disease (CAD) defined as a flow limiting coronary artery stenosis causing a perfusion defect by single photon emission computed tomography (SPECT).<h4>Methods and results</h4>We conducted a multicentre study to evaluate the accuracy of integrated CTA-CTP for the identification of patients with flow-limiting CAD defined by  ...[more]

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