Korean Circ J.  2014 May;44(3):170-176. 10.4070/kcj.2014.44.3.170.

Clinical Utility of Coronary CT Angiography with Stress Perfusion CT in Preoperative Cardiac Risk Evaluation

• Chang SA
• Kim SM
• Choi SH
• Choe YH
• Kim YW
• Kim DK

• KMID: 2145478
• DOI: http://doi.org/10.4070/kcj.2014.44.3.170

Abstract

BACKGROUND AND OBJECTIVES
Vascular surgery carries high operative risk. Recently developed cardiac computed tomography (CT) provides excellent imaging of coronary artery disease (CAD), as well as myocardial perfusions. We investigated the role of stress perfusion CT with coronary computed tomography angiography (CCTA) using 128-slice dual source CT (DSCT) in preoperative cardiac risk evaluation.
SUBJECTS AND METHODS
Patients scheduled for vascular surgery were admitted and underwent the adenosine stress perfusion CT with CCTA using DSCT. Patients who presented with unstable angina, recent myocardial infarction, decompensated heart failure, or renal failure were excluded. Stress perfusion CT was first acquired using sequential mode during adenosine infusion, after which, scanning for CT angiography was followed by helical mode. Perioperative events were followed up for 1 month.
RESULTS
Ninety-one patients completed the study. Most patients (94.5%) had coronary atherosclerosis, with 36 (39.6%) patients had more than 50% coronary artery stenosis. Perfusion defects with significant stenosis were found in 12 cases (13.2%). Revascularization after DSCT was rarely performed. Four patients (4.4%) experienced cardiac events in the perioperative period: two experienced heart failure and two had non-fatal myocardial infarction.
CONCLUSION
We cannot conclude that the stress perfusion CT, with CCTA using DSCT, plays a significant role in preoperative risk evaluation from this study. However, the coronary atherosclerosis and the significant CAD were commonly found. The perfusion defects with significant lesions were found in only small fraction of the patients, and did not contribute to perioperative myocardial infarction or heart failure.

Keyword

Vascular surgical procedure; Coronary artery disease; Multidetector computed tomography; Myocardial perfusion imaging

MeSH Terms

Adenosine
Angina, Unstable
Angiography*
Constriction, Pathologic
Coronary Artery Disease
Coronary Stenosis
Heart Failure
Humans
Multidetector Computed Tomography
Myocardial Infarction
Myocardial Perfusion Imaging
Perfusion*
Perioperative Period
Renal Insufficiency
Vascular Surgical Procedures
Adenosine

Figure

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  Fig. 1 Analysis of CTA and stress perfusion CT image. Patients with significant stenosis with stress induced perfusion defect in RCA territory. CTA shows tight stenosis in mid RCA (A and B), and the corresponding myocardial segments in basal inferior wall shows significant perfusion defect in stress perfusion CT image (C). CTA: computed tomographic angiography, CT: computed tomography, RCA: right coronary artery.

• 

  Fig. 2 Extent of coronary artery disease: CCTA results. Multivessel disease (24%) was prevalent in the patients who underwent vascular surgery. Coronary atherosclerosis was found in most of the patients (94%) (History of coronary revascularization and insignificant stenosis in current CCTA has been considered as significantly diseased vessel in this analysis). CCTA: coronary computed tomography angiography.

• 

  Fig. 3 Result of CCTA and perfusion CT. 94% of the patients had plaques in their coronary arteries and 39% had coronary artery stenosis of more than 50%. However, only a third of the patients with CAD (>50% stenosis) showed a perfusion defect (History of coronary revascularization and insignificant stenosis in current CTA has been considered "insignificant" in this analysis). CCTA: coronary computed tomography angiography, CT: computed tomography, CAD: coronary artery disease.

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