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Hemodynamic Significance of APEXCT Coronary Angiography Combined With Dynamic CT Myocardial Perfusion Imaging in
Liang-Shi Wang1, Tian Bai1, Ji-Zhou Yan2
1Department of Radiological Imaging Center, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang, China.
Insights
This study shows that combining photon-counting CT coronary angiography (APEX-CT CTA) and CT myocardial perfusion imaging (CT-MPI) can accurately assess in-stent restenosis (ISR). These noninvasive methods identify key indicators for hemodynamic significance.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- In-stent restenosis (ISR) after percutaneous coronary intervention (PCI) remains a clinical challenge.
- Accurate assessment of ISR's hemodynamic significance is crucial for guiding patient management.
- Current diagnostic methods may have limitations in fully characterizing ISR.
Purpose of the Study:
- To evaluate the hemodynamic significance of ISR using a combined anatomical-functional approach.
- To assess the utility of photon-counting CT coronary angiography (APEX-CT CTA) and dynamic CT myocardial perfusion imaging (CT-MPI) for ISR evaluation.
- To identify noninvasive predictors of hemodynamically significant ISR.
Main Methods:
- Prospective enrollment of 239 symptomatic patients at least 9 months post-PCI.
- Performance of APEX-CT CTA for diameter stenosis (CTA%DS) and plaque composition.
- Acquisition of CT-MPI for myocardial blood flow (MBF) and relative myocardial blood volume (rMBV).
- Comparison with invasive coronary angiography (CAG) and fractional flow reserve (FFR) as reference standards.
Main Results:
- 41 patients (17.2%) were ISR-positive.
- ISR-positive group showed higher CTA%DS, lipid plaque, diabetes, and smaller/longer stents.
- Lower MBF and rMBV were observed in the ISR-positive group.
- CTA%DS and rMBV > 0.7 were independent predictors of ISR (AUC=0.949).
Conclusions:
- The combination of APEX-CT CTA and CT-MPI provides a dual anatomical-functional assessment of ISR.
- CTA%DS and rMBV are key noninvasive indicators for hemodynamically significant ISR.
- Further validation is needed for long-term applicability and generalizability.
Abstract:
This study aimed to evaluate the hemodynamic significance of in-stent restenosis (ISR) by using a combined anatomical-functional approach with photon-counting CT coronary angiography (APEX-CT CTA) and dynamic CT myocardial perfusion imaging (CT-MPI). We prospectively enrolled 239 symptomatic patients at least 9 months after PCI. All patients underwent APEX-CT CTA (assessing diameter stenosis [CTA%DS] and plaque composition) and CT-MPI (measuring myocardial blood flow [MBF] and relative myocardial blood volume [rMBV]). Invasive coronary angiography (CAG) and fractional flow reserve (FFR) served as the reference standard, with a composite ISR endpoint defined as CAG%DS ≥ 90% or CAG%DS ≥ 50% with FFR ≤ 0.80. Among 239 patients, 41 (17.2%) were ISR-positive. The ISR-positive group had significantly higher CTA%DS, lipid plaque proportion, diabetes prevalence, and smaller/longer stents, but lower MBF and rMBV. Multivariate analysis identified CTA%DS (OR = 6.801, 95% CI: 3.014-15.346) and rMBV > 0.7 (OR = 0.231, 95% CI: 0.079-0.673) as independent predictors, and their combination yielded an AUC of 0.949. In conclusion, APEX-CT CTA combined with CT-MPI enables dual anatomical-functional assessment of ISR, with CTA%DS and rMBV serving as key noninvasive indicators, though further validation of its long-term applicability and generalizability is warranted.
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