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Evaluation of myocardial CT perfusion in patients presenting with acute chest pain to the emergency department: comparison with SPECT-myocardial perfusion imaging
  1. Gudrun Maria Feuchtner1,2,
  2. Fabian Plank2,
  3. Constantino Pena1,
  4. Juan Battle1,
  5. James Min3,
  6. Jonathon Leipsic4,
  7. Troy Labounty3,
  8. Warren Janowitz1,
  9. Barry Katzen1,
  10. Jack Ziffer1,
  11. Ricardo C Cury1
  1. 1Baptist Cardiac and Vascular Institute, Baptist Hospital Miami, Miami, USA
  2. 2Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
  3. 3Cedars Sinai Medical Center, Los Angeles, California, USA
  4. 4University of British Columbia, Vancouver, Canada
  1. Correspondence to Dr Gudrun Maria Feuchtner, Department of Radiology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria 6020; gudrun.feuchtner{at}i-med.ac.at

Abstract

Objective To determine whether evaluation of resting myocardial CT perfusion (CTP) from coronary CT angiography (CTA) datasets in patients presenting with chest pain (CP) to the emergency department (ED), might have added value to coronary CTA.

Design, setting 76 Patients (age 54.9 y±13; 32 (42%) women) presenting with CP to the ED underwent coronary 64-slice CTA. Myocardial perfusion defects were evaluated for CTP (American Heart Association 17-segment model) and compared with rest sestamibi single-photon emission CT myocardial perfusion imaging (SPECT-MPI). CTA was assessed for >50% stenosis per vessel.

Results CTP demonstrated a sensitivity of 92% and 89%, specificity of 95% and 99%, positive predictive value (PPV) of 80% and 82% and negative predictive value (NPV) of 98% and 99% for each patient and for each segment, respectively. CTA showed an accuracy of 92%, sensitivity of 70.4%, specificity of 95.5%, PPV 67.8%, and NPV of 95% compared with SPECT-MPI. When CTP findings were added to CTA the PPV improved from 67% to 90.1%.

Conclusions In patients presenting to the ED with CP, the evaluation of rest myocardial CTP demonstrates high diagnostic performance as compared with SPECT-MPI. Addition of CTP to CTA improves the accuracy of CTA, primarily by reducing rates of false-positive CTA.

  • Coronary CT-angiography
  • acute chest pain
  • myocardial perfusion
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Footnotes

  • Funding GE Healthcare provided a research grant to support this study.

  • Competing interests None.

  • Ethics approval Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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