Felix G. Meinel MD, Presenter: Nothing to Disclose

Francesca Pugliese MD, PhD, Abstract Co-Author: Nothing to Disclose

U. Joseph Schoepf MD, Abstract Co-Author: Research Grant, Bracco Group Research Grant, Bayer AG Research Grant, General Electric Company Research Grant, Siemens AG

Ullrich Ebersberger MD, Abstract Co-Author: Nothing to Disclose

Carlo Nicola de Cecco MD, Abstract Co-Author: Nothing to Disclose

Fabian Bamberg MD, MPH, Abstract Co-Author: Speakers Bureau, Bayer AG Speakers Bureau, Siemens AG Research Grant, Bayer AG Research Grant, Siemens AG

Yining Wang MD, Abstract Co-Author: Nothing to Disclose

Yeon Hyeon Choe MD, PhD, Abstract Co-Author: Nothing to Disclose

Gladys G. Lo MD, Abstract Co-Author: Nothing to Disclose

To determine the prognostic value of stress dynamic CT myocardial perfusion imaging (CTMPI) for future major adverse cardiac events (MACE) in a multicenter population at intermediate to high cardiovascular risk.

We analyzed data of 144 patients from 6 centers in Asia, Europe and North America who had undergone coronary CT angiography (CCTA) and CTMPI. All image acquisitions were performed on a second-generation dual-source CT system. Contrast enhanced CCTA studies were acquired at rest. In addition, CTMPI imaging was performed under vasodilator stress. CCTA data were evaluated for the presence of coronary artery stenosis (>50% luminal narrowing) on a per-vessel basis. CTMPI data were visually evaluated for perfusion defects in each vessel territory. Patient follow-up was obtained at 6, 12 and 18 months after the CT examination. The prognostic value of CT findings was assessed using Kaplan-Meier statistics and multivariate Cox proportional hazards regression.

During the follow-up, 40 MACE occurred (including nonfatal myocardial infarction, n=1, unstable angina, n=13, PCI, n=23, and CABG, n=3). Patients with a perfusion defect in at least one vascular territory on CTMPI were at significantly increased risk for MACE (HR 2.50, 95% confidence interval 1.34-4.65, p=0.0040). This association remained significant after adjusting for age, gender and clinical risk factors (HR 2.41, 1.28-4.51, p=0.0064) and after further adjusting for CCTA findings (HR 2.03, 1.04-3.97, p=0.0390). The number of territories with perfusion defects was strongly predictive of MACE with adjusted HRs of 1.41, 3.44 and 4.76 for 1, 2 and 3 affected territories.

Myocardial perfusion abnormalities detected by CTMPI are predictive for subsequent MACE. CTMPI provides incremental predictive value for future MACE over clinical risk factors and assessment of coronary artery stenosis at CCTA.

CT myocardial perfusion imaging provides incremental predictive value for future adverse cardiac events over clinical risk factors and assessment of coronary artery stenosis at CCTA.

Meinel, F, Pugliese, F, Schoepf, U, Ebersberger, U, de Cecco, C, Bamberg, F, Wang, Y, Choe, Y, Lo, G, Prognostic Value of Stress Dynamic CT Myocardial Perfusion Imaging in a Multi-Center Population at Intermediate to High Cardiovascular Risk.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007299.html