Exploring the clinical profile of patients studied by dynamic myocardial perfusion computed tomography
Authors: Francesc Altadill Balsells F , Carlos Gonzalez Freixa C , Lidia Bos Real L , Mario Salido Iniesta M , Juan Fernandez Martinez J , Irene Menduina Gallego I , Chi Hion Li C , Sandra Pujadas Olano S , Martin Descalzo Buey M , Ruben Leta Petracca R , David Vilades Medel D 
Published: June 2024

Abstract

Introduction
The use of multidetector computed tomography (MDCT) is becoming increasingly common in patients with intermediate or high pretest risk of coronary artery disease (CAD) or a history of chronic coronary syndrome (CCS). This may reduce its diagnostic accuracy, prompting a greater use of complementary functional imaging tests. Dynamic myocardial perfusion computed tomography (DynCTP) represents a tool capable of providing functional information that complements the anatomical study in a single non-invasive test.

Purpose
To characterize the baseline characteristics of a cohort of symptomatic patients with suspected CAD (with intermediate to high pretest risk) or a history of CCS examined through MDCT and DynCTP, and to analyze the results of the combination of both techniques.

Methods
Prospective and single-center observational study including unselected patients undergoing MDCT followed by DynCTP if CADRADS ≥ 3 or nonconclusive coronary segments were identified between April 2021 and April 2023. Technique outcomes were assessed using a composite of major cardiovascular events (MACE): cardiovascular mortality, acute coronary syndrome (ACS) and the need for revascularization.

Results
A total of 102 patients were included with a mean follow-up of 1.8 ± 0.6 years. Table 1 summarizes their baseline characteristics. DynCTP was performed in 55% of patients, and it was positive in 77% of them. Patients who underwent DynCTP showed higher pretest risk, percentage of previous CCS and atherosclerotic burden. Subjects who underwent both tests received higher radiation doses (532 ± 244 mGy vs. 247 ± 211 mGy; p &lt; 0.01) and contrast volume (112 ± 18 mL vs. 71 ± 4 mL; p &lt; 0.01) than those studied only by MDCT.
DynCTP yielded positive results in 38% of patients with CAD-RADS 3, 88% in cases of CAD-RADS 4 and in all cases of CAD-RADS 5. None of the patients with CAD-RADS less than 3 showed a positive result.
Patients with a positive result in DynCTP had higher atherosclerotic burden measured by CAD-RADS (4.3 ± 0.6 vs. 2.8 ± 0.9), segment involvement score (SIS) (9.1 ± 2.1 vs. 6.4 ± 3.4), and segment stenosis score (SSS) (5 ± 3.5 vs. 10.9 ± 5.9) compared to those with a negative finding (p &lt; 0.01 for all comparisons). No significant differences were observed in the prevalence of cardiovascular risk factors, pretest risk or history of CCS (p &gt; 0.05 for all comparisons).
Patients with a positive DynCTP result underwent more cardiac catheterizations and coronary revascularization procedures, experiencing a higher incidence of MACE compared to those with a negative outcome (see Table 2).

Conclusions
In our population, the patients who underwent DynCTP had a higher pretest probability of CAD, prevalence of CCS and atherosclerotic burden, although only the latter factor was associated with a positive DynCTP. A positive DynCTP study was associated with a higher incidence of cardiac catheterizations, coronary revascularizations, and ACS in the follow-up.Baseline characteristics of patients Incidence of major cardiovascular events