Impact of Abnormal Remote Stress Myocardial Blood Flow by Dynamic CT Perfusion on Clinical Outcomes.
Nobuo TomizawaShengpu ChouYusuke FujinoSatoshi MatsuokaKodai YamamotoShinichi InohTakeshi NojoKanako K KumamaruShinichiro FujimotoSunao NakamuraPublished in: Scientific reports (2020)
The objective of this study was to investigate the incremental prognostic value for adverse events of myocardial blood flow (MBF) derived from stress computed tomography perfusion (CTP) at remote myocardium over cardiac risk factors and ischemia. We prospectively analyzed 242 patients who underwent dynamic CTP and CT angiography. Adverse events were defined as a composite of all-cause mortality, non-fatal myocardial infarction, unstable angina, heart failure requiring hospitalization, peripheral artery disease, and stroke. MBF value was calculated in each myocardial segment and ischemia was defined as mild decrease in MBF in two consecutive segments or moderate decrease in a single segment accompanied with a coronary stenosis ≥50%. The mean MBF of the non-ischemic segments was defined as remote MBF. We divided the patients into two groups by median MBF value of 1.15 ml/min/g. During a median follow-up of 18 months, 18 patients had adverse events. Annual event rate showed a significant difference between patients with low (≤1.15 ml/min/g) and high (>1.15 ml/min/g) MBF (6.1% vs 1.8%, p = 0.02). Univariate analysis showed that low MBF was a significant predictor of events (hazard ratio (HR): 3.4; 95% confidence interval (CI): 1.2 to 12.0; p = 0.02). This relationship maintained significant after adjusted for the presence of ischemia and cardiac risk factors (HR: 3.0; 95%CI: 1.1 to 11.1; p = 0.04). In conclusion, MBF value ≤1.15 ml/min/g derived from dynamic CTP in remote myocardium is significantly related with poor outcome and this relationship was independent of myocardial ischemia and cardiac risk factors.
Keyphrases
- risk factors
- left ventricular
- blood flow
- heart failure
- computed tomography
- end stage renal disease
- ejection fraction
- newly diagnosed
- prognostic factors
- magnetic resonance imaging
- peritoneal dialysis
- coronary artery
- contrast enhanced
- magnetic resonance
- ischemia reperfusion injury
- percutaneous coronary intervention
- blood brain barrier
- dual energy
- acute coronary syndrome
- high intensity
- heat stress
- pet ct