Transmural myocardial perfusion gradients in relation to coronary artery stenoses severity assessed by cardiac multidetector computed tomography
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Transmural myocardial perfusion gradients in relation to coronary artery stenoses severity assessed by cardiac multidetector computed tomography. / Linde, Jesper James; Kühl, Jørgen Tobias; Hove, Jens Dahlgaard; Sørgaard, Mathias; Kelbæk, Henning; Nielsen, Walter Bjørn; Kofoed, Klaus Fuglsang.
I: International Journal of Cardiovascular Imaging, Bind 31, Nr. 1, 01.2015, s. 171-180.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Transmural myocardial perfusion gradients in relation to coronary artery stenoses severity assessed by cardiac multidetector computed tomography
AU - Linde, Jesper James
AU - Kühl, Jørgen Tobias
AU - Hove, Jens Dahlgaard
AU - Sørgaard, Mathias
AU - Kelbæk, Henning
AU - Nielsen, Walter Bjørn
AU - Kofoed, Klaus Fuglsang
PY - 2015/1
Y1 - 2015/1
N2 - 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 ≥50 % was present in 49 patients (25 %). Rest-PI and rest-TPR values were similar in patients with and without a coronary artery stenosis ≥50 %, whereas stress-PI, stress-TPR and MPR were significantly reduced in patients with a stenosis ≥50 % (p < 0.001, p < 0.0001 and 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 ≥50 % 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.
AB - 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 ≥50 % was present in 49 patients (25 %). Rest-PI and rest-TPR values were similar in patients with and without a coronary artery stenosis ≥50 %, whereas stress-PI, stress-TPR and MPR were significantly reduced in patients with a stenosis ≥50 % (p < 0.001, p < 0.0001 and 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 ≥50 % 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.
KW - Adenosine
KW - Adult
KW - Aged
KW - Coronary Circulation
KW - Coronary Stenosis
KW - Coronary Vessels
KW - Denmark
KW - Female
KW - Hemodynamics
KW - Humans
KW - Hyperemia
KW - Male
KW - Middle Aged
KW - Multidetector Computed Tomography
KW - Myocardial Perfusion Imaging
KW - Observer Variation
KW - Predictive Value of Tests
KW - Prognosis
KW - Reproducibility of Results
KW - Severity of Illness Index
KW - Vasodilator Agents
U2 - 10.1007/s10554-014-0530-9
DO - 10.1007/s10554-014-0530-9
M3 - Journal article
C2 - 25194436
VL - 31
SP - 171
EP - 180
JO - International Journal of Cardiovascular Imaging
JF - International Journal of Cardiovascular Imaging
SN - 1569-5794
IS - 1
ER -
ID: 152269872