title: Rest and stress transluminal attenuation gradient and contrast opacification difference for detection of hemodynamically significant stenoses in patients with suspected coronary artery disease.
abstract: This study evaluated the feasibility of stress 320 detector CT coronary angiography (CTA) derived transluminal attenuation gradient (TAG320) and contrast opacification (CO) difference to detect hemodynamically significant stenoses as determined by invasive fractional flow reserve (FFR ≤ 0.80). Twenty-seven patients, including 51 vessels on rest CTA were studied. 16 (31 %) vessels were not interpretable on stress CTA largely secondary to motion artefacts. Receiver operating characteristic curve analysis showed a comparable area under the curve (AUC) for rest and stress TAG320 (0.78 and 0.75) which was higher than CTA alone (0.68), and rest and stress CO difference (0.76 and 0.67). Compared with rest CTA, stress CTA demonstrated inferior image quality (Median Likert score 4 vs. 3, P < 0.0001) and required a higher mean radiation exposure (3.2 vs. 5.1 mSv, P < 0.0001). Stress TAG320 and CO difference is less feasible and was not superior in diagnostic performance when compared with rest TAG320 and CO difference.
authors.affiliation: Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia. brianshiuhangko@gmail.com.|Monash Heart, 246 Clayton Road, Clayton, VIC, 3168, Australia. brianshiuhangko@gmail.com.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Ko
authors.affiliation: Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia.
authors.forename: Sujith
authors.initials: S
authors.lastname: Seneviratne
authors.affiliation: Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia.
authors.forename: James D
authors.initials: JD
authors.lastname: Cameron
authors.affiliation: Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gutman
authors.affiliation: Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia.|Department of Diagnostic Imaging, MMC, Monash Health and Monash University, Melbourne, Australia.
authors.forename: Marcus
authors.initials: M
authors.lastname: Crossett
authors.affiliation: Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia.
authors.forename: Kiran
authors.initials: K
authors.lastname: Munnur
authors.affiliation: Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia.
authors.forename: Ian T
authors.initials: IT
authors.lastname: Meredith
authors.affiliation: Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia.|South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.
authors.forename: Dennis T L
authors.initials: DT
authors.lastname: Wong
mesh_terms: D000368:Aged; D019540:Area Under Curve; D016477:Artifacts; D000072226:Computed Tomography Angiography; D003287:Contrast Media / Q000008:administration & dosage*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006439:Hemodynamics; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D011829:Radiation Dosage; D000069079:Radiation Exposure; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014739:Victoria
chemical_list: D003287:Contrast Media; D007472:Iohexol
keywords: CT coronary angiography; Fractional flow reserve; Invasive angiography; Transluminal attenuation gradient