title: Relation between quantitative coronary CTA and myocardial ischemia by adenosine stress myocardial CT perfusion.
abstract: Coronary-computed tomography angiography (CTA) has limited accuracy to predict myocardial ischemia. Besides luminal area stenosis, other coronary plaque morphology and composition parameters may help to assess ischemia. With the integration of coronary CTA and adenosine stress CT myocardial perfusion (CTP), reliable information regarding coronary anatomy and function can be derived in one procedure. This analysis aimed to investigate the association between coronary stenosis severity, plaque composition and morphology and the presence of ischemia measured with adenosine stress myocardial CTP.
  
  
  
  84 patients (age, 62 ± 10 years; 48% men) who underwent sequential coronary CTA and adenosine stress myocardial CT perfusion were analyzed. Automated quantification was performed in all coronary lesions (quantitative CTA). Downstream myocardial ischemia was assessed by visual analysis of the rest and stress CTP images and defined as a summed difference score of ≥1. One or more coronary plaques were present in 146 coronary arteries of which 31 (21%) were ischemia-related. Of the lesions with a stenosis percentage <50%, 50%-70%, and >70%, respectively, 9% (6/67), 18% (9/51), and 57% (16/28) demonstrated downstream ischemia. Furthermore, mean plaque burden, plaque volume, lesion length, maximal plaque thickness, and dense calcium volume were significantly higher in ischemia-related lesions, but only stenosis severity (%) (OR 1.06; 95% CI 1.02-1.10; P = .006) and lesion length (mm) (OR 1.26; 95% CI 1.02-1.55; P = .029) were independent correlates.
  
  
  
  Increasing stenosis percentage by quantitative CTA is positively correlated to myocardial ischemia measured with adenosine stress myocardial CTP. However, stenosis percentage remains a moderate determinant. Lumen area stenosis and lesion length were independently associated with ischemia, adjusted for coronary plaque volume, mean plaque burden, maximal lesion thickness, and dense calcium volume.
authors: Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 2300 RC, Leiden, The Netherlands.|The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors: Alexander R
authors: AR
authors: van Rosendael
authors: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Lucia J
authors: LJ
authors: Kroft
authors: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Alexander
authors: A
authors: Broersen
authors: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Jouke
authors: J
authors: Dijkstra
authors: Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 2300 RC, Leiden, The Netherlands.
authors: Inge J
authors: IJ
authors: van den Hoogen
authors: Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Leiden, The Netherlands.
authors: Erik W
authors: EW
authors: van Zwet
authors: Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 2300 RC, Leiden, The Netherlands.
authors: Jeroen J
authors: JJ
authors: Bax
authors: Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 2300 RC, Leiden, The Netherlands.
authors: Michiel A
authors: MA
authors: de Graaf
authors: Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 2300 RC, Leiden, The Netherlands. a.j.h.a.scholte@lumc.nl.
authors: Arthur J
authors: AJ
authors: Scholte
mesh_terms: D000241:Adenosine / Q000494:pharmacology*; D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D000241:Adenosine
keywords: Coronary artery disease; imaging; myocardial CT perfusion; myocardial ischemia; quantitative coronary CTA