Morphologic and functional assessment of coronary artery disease--potential application of computed tomography angiography and myocardial perfusion imaging

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Coronary artery disease (CAD) risk stratification is crucial for patient management.
• Myocardial perfusion imaging (MPI) and computed tomography angiography (CTA) are established diagnostic tools.
• Evaluating combined MPI and CTA data, including high-risk plaque (HRP) features, may improve risk assessment.

Purpose of the Study:

• To assess the combined diagnostic and prognostic value of MPI and CTA in patients with suspected CAD.
• To determine if high-risk plaque (HRP) features on CTA improve risk stratification beyond traditional stenosis assessment and MPI findings.

Main Methods:

• Retrospective analysis of 304 patients who underwent both CTA and MPI.
• CTA analysis included luminal stenosis and HRP features (positive remodeling, low attenuation).
• MPI analysis included summed stress scores (SSS) and summed difference scores (SDS).
• Cardiac events were defined as acute coronary events or revascularization. Survival analysis was performed.

Main Results:

• HRP on CTA and stenosis with SDS >0 were significant independent predictors of cardiac events (HR 4.75, P=0.00171 and HR 4.58, P=0.0461, respectively).
• Patients with HRP had significantly higher event rates (16.1%) compared to those without (2.7%, P=0.0013).
• The combination of stenosis and abnormal MPI (SDS >0) also showed a higher event rate (P=0.0490).

Conclusions:

• High-risk plaques (HRP) identified on CTA are a strong independent predictor of acute coronary events.
• Stenosis combined with abnormal MPI findings (SDS >0) also predicts cardiac events.
• HRP on CTA provides incremental prognostic value beyond traditional stenosis assessment and abnormal MPI findings for CAD risk stratification.