Cineangiography/methods

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Editorial

Myocardial Computed Tomography Perfusion: One More Piece on The Board

The most appropriate way to evaluate patients with stable coronary artery disease (CAD) and the subsequent definition of the therapeutic approach has been the subject of debate in recent years. For several years the anatomical evaluation was considered sufficient to indicate myocardial revascularization. The emergence of several methods of non-invasive functional evaluation in clinical practice as well as data from observational studies demonstrating that there is a level of ischemia above which a revascularization strategy might result in benefit regarding cardiovascular events raised doubts whether an strategy based in coronary anatomic findings was the best option.^, This questioning changed the paradigm of CAD evaluation. Although randomized clinical trials have failed to demonstrate that the extent of ischemia can determine which patients would benefit from a revascularization strategy,^– the fact that the presence of moderate to severe ischemia is undeniably a marker of cardiovascular risk has lead functional evaluation to become a fundamental part in the management of patients with stable CAD.

In this context, Ker et al. in this edition of the Arquivos Brasileiros de Cardiologia evaluated 35 patients undergoing a simultaneous pharmacologic stress protocol of myocardial perfusion evaluation by computed tomography angiography (angio-CT) and single-photon emission computed tomography (SPECT) and compared the sensitivity of the methods using the presence of obstructive lesion evidenced by angio-CT greater than 50% as the gold standard for the presence of significant CAD.

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Original Article

Myocardial Perfusion by Coronary Computed Tomography in the Evaluation of Myocardial Ischemia: Simultaneous Stress Protocol with SPECT

Wilter dos Santos Ker et al. Daniel Gama das Neves Tiago Augusto Magalhães Alair Augusto Sarmet M. D. dos Santos … Claudio Tinoco Mesquita Marcelo Souto Nacif

Abstract

Background:

Functional assessment to rule out myocardial ischemia using coronary computed tomography angiography (CCTA) is extremely important and data on the Brazilian population are still limited.

Objective:

To assess the diagnostic performance of myocardial perfusion by CCTA in the detection of severe obstructive coronary artery disease (CAD) compared with single-photon emission computerized tomography (SPECT). To analyze the importance of anatomical knowledge to understand the presence of myocardial perfusion defects on SPECT imaging that is not identified on computed tomography (CT) scan.

Method:

A total of 35 patients were evaluated by a simultaneous pharmacologic stress protocol. Fisher’s exact test was used to compare proportions. The patients were grouped according to the presence or absence of significant CAD. The area under the ROC curve was used to identify the diagnostic performance of CCTA and SPECT in perfusion assessment. P < 0.05 values were considered statistically significant.

Results:

For detection of obstructive CAD, CT myocardial perfusion analysis yielded an area under the ROC curve of 0.84 [a 95% confidence interval (CI95%): 0.67-0.94, p < 0.001]. SPECT myocardial perfusion imaging, on the other hand, showed an AUC of 0.58 (95% CI 0.40 – 0.74, p < 0.001). In this study, false-positive results with SPECT are described.

Conclusion:

Myocardial perfusion analysis by CTA displays satisfactory results compared to SPECT in the detection of obstructive CAD. CCTA can rule out false-positive results of SPECT.