Transmural myocardial perfusion gradients in relation to coronary artery stenoses severity assessed by cardiac multidetector computed tomography

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• 作者：Jesper James Linde ; J?rgen Tobias Kühl…
• 关键词：Myocardial computed tomographic perfusion ; Computed tomographic angiography ; Coronary stenosis severity ; Coronary artery disease
• 刊名：The International Journal of Cardiovascular Imaging (formerly Cardiac Imaging)
• 出版年：2015
• 出版时间：January 2015
• 年：2015
• 卷：31
• 期：1
• 页码：171-180
• 全文大小：382 KB
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• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Cardiology
  
• 出版者：Springer Netherlands
• ISSN：1573-0743

文摘

To assess the relationship between epicardial coronary artery stenosis severity and the corresponding regional transmural perfusion at rest and during adenosine stress, using multidetector computed tomography (MDCT). We evaluated the relationship between the severity of coronary artery diameter stenosis assessed by MDCT angiography and semi-quantitative myocardial MDCT perfusion in 200 symptomatic patients. The perfusion index (PI?=?mean myocardial attenuation density/mean left ventricular lumen attenuation density) at rest and during adenosine stress, the myocardial perfusion reserve (MPR?=?stress???PI/rest???PI), and the transmural perfusion ratio (TPR?=?subendocardium/subepicardium) were calculated. A coronary artery stenosis ?0?% was present in 49 patients (25?%). Rest-PI and rest-TPR values were similar in patients with and without a coronary artery stenosis ?0?%, whereas stress-PI, stress-TPR and MPR were significantly reduced in patients with a stenosis ?0?% (p?p?p?=?0.02, respectively). Subendocardial PI was significantly higher than subepicardial PI at rest and during stress for patients without a significant stenosis, whereas this difference was blurred during stress in patients with ?0?% stenosis. In a broad spectrum of stenosis severity groups, TPR at rest remained unchanged until the group of patients with total occlusions, whereas TPR during stress decreased progressively when a threshold of 50?% was superseded. In this study we establish the relationship between semi-quantitative perfusion measurements by MDCT and severity of coronary artery stenoses and find the transmural myocardial perfusion ratio to be a potential strong functional index of the hemodynamic significance of coronary artery atherosclerotic lesions.