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Prediction of clinical outcome by myocardial CT perfusion in patients with low-risk unstable angina pectoris

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Abstract

The prognostic implications of myocardial computed tomography perfusion (CTP) analyses are unknown. In this sub-study to the CATCH-trial we evaluate the ability of adenosine stress CTP findings to predict mid-term major adverse cardiac events (MACE). In 240 patients with acute-onset chest pain, yet normal electrocardiograms and troponins, a clinically blinded adenosine stress CTP scan was performed in addition to conventional diagnostic evaluation. A reversible perfusion defect (PD) was found in 38 patients (16 %) and during a median follow-up of 19 months (range 12–22 months) 25 patients (10 %) suffered a MACE (cardiac death, non-fatal myocardial infarction and revascularizations). Accuracy for the prediction of MACE expressed as the area under curve (AUC) on receiver-operating characteristic curves was 0.88 (0.83–0.92) for visual assessment of a PD and 0.80 (0.73–0.85) for stress TPR (transmural perfusion ratio). After adjustment for the pretest probability of obstructive coronary artery disease, both detection of a PD and stress TPR were significantly associated with MACE with an adjusted hazard ratio of 39 (95 % confidence interval 11–134), p < 0.0001, for visual interpretation and 0.99 (0.98–0.99) for stress TPR, p < 0.0001. Patients with a PD volume covering >10 % of the LV myocardium had a worse prognosis compared to patients with a PD covering <10 % of the LV myocardium, p = 0.0002. The optimal cut-off value of the myocardial PD extent to predict MACE was 5.3 % of the left ventricle [sensitivity 84 % (64–96), specificity 95 % (91–97)]. Myocardial CT perfusion parameters predict mid-term clinical outcome in patients with recent acute-onset chest pain.

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Acknowledgments

Chief Radiographer Kim Madsen, research secretary Betina Hansen, and project nurses Kirsten Thrysøe, Aslaug Karlsdottir, and Christina Møller are thanked for excellent logistic and technical assistance.

Funding

This work was supported by The Danish Heart Foundation (Grant Number 12-04-R90_A3921-22718), Copenhagen, Denmark and the Danish Agency for Science, Technology and Innovation by The Danish Council for Strategic Research (EDITORS: Eastern Denmark Initiative to imprOve Revascularization Strategies, Grant 09-066994), Copenhagen, Denmark.

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Authors and Affiliations

  1. Department of Cardiology, Hvidovre University Hospital, University of Copenhagen, Kettegaard alle 30, 2650, Hvidovre, Denmark

    Jesper J. Linde, Jens D. Hove & Walter B. Nielsen

  2. Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Jesper J. Linde, Mathias Sørgaard, Jørgen T. Kühl & Klaus F. Kofoed

  3. Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Klaus F. Kofoed

  4. Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark

    Henning Kelbæk

  5. Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark

    Jens D. Hove

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  1. Jesper J. Linde
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  2. Mathias Sørgaard
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Correspondence to Jesper J. Linde.

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Conflict of interest

Authors Jesper James Linde, Mathias Sørgaard and Klaus Fuglsang Kofoed have received lecturing fees from Toshiba Medical Systems. Authors Jens Dahlgaard Hove, Jørgen Tobias Kühl, Henning Kelbæk and Walter Bjørn Nielsen have not declared any conflicts.

Ethical approval

The study was approved by the local ethical committee and all patients gave written consent before randomization. The study was performed in accordance with the 1964 Helsinki declaration.

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Linde, J.J., Sørgaard, M., Kühl, J.T. et al. Prediction of clinical outcome by myocardial CT perfusion in patients with low-risk unstable angina pectoris. Int J Cardiovasc Imaging 33, 261–270 (2017). https://doi.org/10.1007/s10554-016-0994-x

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  • DOI: https://doi.org/10.1007/s10554-016-0994-x

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