title: Global quantification of left ventricular myocardial perfusion at dynamic CT imaging: Prognostic value.
abstract: BACKGROUND
  There is no published data on the prognostic value of global myocardial perfusion values at stress dynamic CT myocardial perfusion imaging (CTMPI).
  
  
  METHODS
  Data of 144 patients from 6 centers who had undergone coronary CT angiography (coronary CTA) and CTMPI were assessed. Coronary CTA studies were acquired at rest; CTMPI was performed under vasodilator stress. Coronary CTA data were evaluated for coronary artery stenosis (≥50% luminal narrowing) on a per-vessel basis. Volumes-of-interest were placed over the entire left ventricular myocardium to obtain global myocardial blood flow (MBF), myocardial blood volume (MBV), and volume transfer constant (Ktrans). Follow-up was obtained at 6/12/18 months. Major adverse cardiac events (MACE, defined as cardiac death, non-fatal myocardial infarction, unstable angina requiring hospitalization, and revascularization) served as the endpoint.
  
  
  RESULTS
  MACE occurred in 40 patients (nonfatal myocardial infarction, n = 1, unstable angina, n = 13, PCI, n = 23, and CABG, n = 3). Patients with global MBF of <121 mL/100 mL/min were at increased risk for MACE (HR 2.07, 95% confidence interval [CI]: 1.12-3.84, p = 0.02). This association remained significant after adjusting for age, gender, and clinical risk factors (HR 2.17, 95%CI: 1.16-4.06, p = 0.02), after further adjusting for presence of ≥50% stenosis at coronary CTA (HR 2.18, 95%CI: 1.16-4.10, p = 0.02) and when excluding early (<6 months) revascularizations (HR 2.34, 95%CI: 1.01-5.43, p = 0.0486). Global MBV and Ktranswere not independent predictors of MACE.
  
  
  CONCLUSIONS
  Global quantification of left ventricular MBF at stress dynamic CTMPI may have incremental predictive value for future MACE over clinical risk factors and assessment of stenosis at coronary CTA.
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Meinel
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Julian L
authors.initials: JL
authors.lastname: Wichmann
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States. Electronic address: schoepf@musc.edu.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.affiliation: Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and the London School of Medicine, Queen Mary University of London, UK.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pugliese
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.
authors.forename: Ullrich
authors.initials: U
authors.lastname: Ebersberger
authors.affiliation: Department of Diagnostic and Interventional Radiology, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, China.
authors.forename: Gladys G
authors.initials: GG
authors.lastname: Lo
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Yeon Hyeon
authors.initials: YH
authors.lastname: Choe
authors.affiliation: Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Yining
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Tesche
authors.affiliation: Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and the London School of Medicine, Queen Mary University of London, UK; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Segreto
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
authors.forename: Wolfgang G
authors.initials: WG
authors.lastname: Kunz
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
authors.forename: Kolja M
authors.initials: KM
authors.lastname: Thierfelder
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Tübingen, Tübingen, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Latina, Italy.
authors.forename: Carlo N
authors.initials: CN
authors.lastname: De Cecco
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D001208:Asia; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D005060:Europe; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States
keywords: Computed tomography; Coronary artery disease; Ischemic heart disease; Myocardial perfusion imaging; Outcome; Prognosis