title: Dynamic CT myocardial perfusion imaging identifies early perfusion abnormalities in diabetes and hypertension: Insights from a multicenter registry.
abstract: BACKGROUND
  To identify patients with early signs of myocardial perfusion reduction, a reference base for perfusion measures is needed.
  
  
  OBJECTIVE
  To analyze perfusion parameters derived from dynamic computed tomography perfusion imaging (CTPI) in patients with suspected coronary artery disease (CAD), and relationship with risk factors.
  
  
  METHODS
  In this multicenter study, coronary CT angiography (cCTA) and dynamic CTPI were performed by second-generation dual-source CT in patients suspected of CAD. Risk factors were collected from hospital records. Patients with visual perfusion defects on CTPI, previous coronary intervention, or missing risk factor details were excluded. This analysis included 98 patients (mean age ± standard deviation [SD], 59.0 ± 8.6yrs; 73 male). Global measures of left ventricular myocardial blood flow (MBF), myocardial blood volume (MBV) and volume transfer constant (K(trans)) were calculated.
  
  
  RESULTS
  Mean MBF was 139.3 ± 31.4 mL/100 mL/min, MBV 19.1 ± 2.7 mL/100 mL, and Ktrans 85.0 ± 17.5 mL/100 mL/min. No significant differences in perfusion parameters were found by gender or age category. Hypertension and diabetes mellitus resulted in lower perfusion parameters (hypertension vs normotension: MBV 18.5 ± 3.0 vs 19.7 ± 2.3 mL/100 mL and K(trans) 82.0 ± 18.0 vs 89.0 ± 16.0, p < 0.05; diabetes vs no diabetes: MBF 128.5 ± 31.5 vs 144.0 ± 30.5 mL/100 mL/min and MBV 17.9 ± 2.4 vs 19.4 ± 2.8 mL/100 mL, p < 0.05). In patients with hyperlipidemia, MBF was higher (146.8 ± 34.4 vs 130.7 ± 24.3 mL/100 mL/min, p < 0.05). Smoking and family history did not show perfusion parameter differences.
  
  
  CONCLUSIONS
  Dynamic CTPI identifies early perfusion disturbances in conditions like diabetes and hypertension. With further standardization, absolute perfusion measures may improve CAD risk stratification in patients without visual perfusion defects.
authors.affiliation: Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, 25 Courtenay Drive, Charleston, SC, 29425, USA; University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Department of Radiology, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. Electronic address: r.vliegenthart@umcg.nl.
authors.forename: Rozemarijn
authors.initials: R
authors.lastname: Vliegenthart
authors.affiliation: Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, 25 Courtenay Drive, Charleston, SC, 29425, USA. Electronic address: carlodececco@gmail.com.
authors.forename: Carlo N
authors.initials: CN
authors.lastname: De Cecco
authors.affiliation: Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, 25 Courtenay Drive, Charleston, SC, 29425, USA; University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. Electronic address: docwichmann@gmail.com.
authors.forename: Julian L
authors.initials: JL
authors.lastname: Wichmann
authors.affiliation: Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, 25 Courtenay Drive, Charleston, SC, 29425, USA; Ludwig-Maximilians-University Hospital, Institute for Clinical Radiology, Marchioninistr. 15, 81377, Munich, Germany. Electronic address: fmeinel@med.lmu.de.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Meinel
authors.affiliation: University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Department of Radiology, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. Electronic address: g.j.pelgrim@umcg.nl.
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: Pelgrim
authors.affiliation: Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, 25 Courtenay Drive, Charleston, SC, 29425, USA; Heart Center Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich Municipal Hospital Group, Englschalkinger Str. 77, 81925, Munich, Germany. Electronic address: tesche@musc.edu.
authors.forename: Christian
authors.initials: C
authors.lastname: Tesche
authors.affiliation: Heart Center Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich Municipal Hospital Group, Englschalkinger Str. 77, 81925, Munich, Germany. Electronic address: ebersberger@gmx.net.
authors.forename: Ullrich
authors.initials: U
authors.lastname: Ebersberger
authors.affiliation: Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, UK William Harvey Research Institute, Barts Heart Centre, 2nd Floor Cardiac Imaging, West Smithfield, London, EC1A 7BE, UK. Electronic address: f.pugliese@qmul.ac.uk.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pugliese
authors.affiliation: University of Tuebingen, Department of Radiology, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany. Electronic address: fabian.bamberg@uni-tuebingen.de.
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.affiliation: Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Radiology, 81 Ilwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. Electronic address: ychoe11@gmail.com.
authors.forename: Yeon Hyeon
authors.initials: YH
authors.lastname: Choe
authors.affiliation: Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Department of Radiology, No.1 Shuaifuyuan, Wangfujing, DongCheng District, Beijing, 100730, China. Electronic address: wangyining@pumch.cn.
authors.forename: Yining
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, 25 Courtenay Drive, Charleston, SC, 29425, USA; Medical University of South Carolina, Division of Cardiology, Department of Medicine, 25 Courtenay Drive, Charleston, SC, 29425, USA. Electronic address: schoepf@musc.edu.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
mesh_terms: D000368:Aged; D001208:Asia; D001783:Blood Flow Velocity; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D042241:Early Diagnosis; D005060:Europe; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States
keywords: Cardiovascular risk factors; Computed tomography; Dynamic perfusion; Myocardial blood flow; Myocardial perfusion imaging