title: Diagnosis of functionally significant coronary stenosis with exercise CT myocardial perfusion imaging.
abstract: OBJECTIVE
  To assess the feasibility of exercise perfusion computed tomography (CT) in patients suspected of having hemodynamically significant coronary stenosis.
  
  
  METHODS
  This study had institutional review board approval, and all patients gave informed consent. Thirty-two consecutive patients (26 men [mean age, 63 years] and six women [mean age, 71 years]) with 55 coronary stenoses of at least 50% underwent coronary CT angiography (one stenosis in 13 patients, two stenoses in 15 patients, and three stenoses in four patients). CT myocardial perfusion imaging was performed within 1 minute after patients performed supine exercise on an ergometer secured to the CT table. The pressure-rate product was computed to assess level of exercise. The myocardial enhancement ratio between stenotic and normally perfused territories was determined for each stenosis. Fractional flow reserve less than 0.8, as measured during invasive coronary angiography, was the reference for defining significant stenoses. Receiver operating characteristic curves were constructed to determine the myocardial enhancement ratio cutoff value.
  
  
  RESULTS
  In the per-patient analysis, a myocardial enhancement ratio cutoff of 0.8 performed best for identifying functionally significant stenosis: Sensitivity was 95% (21 of 22 patients), specificity was 90% (nine of 10 patients), positive predictive value was 95% (21 of 22 patients), negative predictive value was 90% (nine of 10 patients), and accuracy was 94% (30 of 32 patients). Corresponding values in the per-stenosis analysis were 97% (29 of 30 stenoses), 96% (23 of 24 stenoses), 97% (29 of 30 stenoses), 96% (23 of 24 stenoses), and 96% (52 of 54 stenoses), respectively.
  
  
  CONCLUSIONS
  Exercise CT myocardial perfusion imaging is feasible and accurate for assessment of the functional significance of coronary stenosis.
authors.affiliation: From the Department of Cardiology, Centre Medico Chirurgical Parly 2, Le Chesnay, France (M.H.); Departments of Cardiology (S.G.) and Radiology (A.R., J.F.P.), Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France; Department of Physiology, School of Medicine, Université Paris-Sud, Le Kremlin-Bicêtre, France (A.C.); and INSERM UMR 999, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France (A.C.).
authors.forename: Michel
authors.initials: M
authors.lastname: Habis
authors.forename: Said
authors.initials: S
authors.lastname: Ghostine
authors.forename: Adela
authors.initials: A
authors.lastname: Rohnean
authors.forename: André
authors.initials: A
authors.lastname: Capderou
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Paul
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005080:Exercise Test / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed