Rochitte, Carlos E3; George, Richard T3; Chen, Marcus Y3; Arbab-Zadeh, Armin3; Dewey, Marc3; Miller, Julie M3; Niinuma, Hiroyuki3; Yoshioka, Kunihiro3; Kitagawa, Kakuya3; Nakamori, Shiro3; Laham, Roger3; Vavere, Andrea L3; Cerci, Rodrigo J3; Mehra, Vishal C3; Nomura, Cesar3; Kofoed, Klaus F1; Jinzaki, Masahiro3; Kuribayashi, Sachio3; de Roos, Albert3; Laule, Michael3; Tan, Swee Yaw3; Hoe, John3; Paul, Narinder3; Rybicki, Frank J3; Brinker, Jeffery A3; Arai, Andrew E3; Cox, Christopher3; Clouse, Melvin E3; Di Carli, Marcelo F3; Lima, Joao A C3
1 Hjertemedicinsk Klinik, Hjertecentret Rigshospitalet, Rigshospitalet, The Capital Region of Denmark2 Radiologisk Klinik, Diagnostisk Center, Rigshospitalet, The Capital Region of Denmark3 unknown
the CORE320 study
AIMS: To evaluate the diagnostic power of integrating the results of computed tomography angiography (CTA) and CT myocardial perfusion (CTP) to identify coronary artery disease (CAD) defined as a flow limiting coronary artery stenosis causing a perfusion defect by single photon emission computed tomography (SPECT). METHODS AND RESULTS: We conducted a multicentre study to evaluate the accuracy of integrated CTA-CTP for the identification of patients with flow-limiting CAD defined by ≥50% stenosis by invasive coronary angiography (ICA) with a corresponding perfusion deficit on stress single photon emission computed tomography (SPECT/MPI). Sixteen centres enroled 381 patients who underwent combined CTA-CTP and SPECT/MPI prior to conventional coronary angiography. All four image modalities were analysed in blinded independent core laboratories. The prevalence of obstructive CAD defined by combined ICA-SPECT/MPI and ICA alone was 38 and 59%, respectively. The patient-based diagnostic accuracy defined by the area under the receiver operating characteristic curve (AUC) of integrated CTA-CTP for detecting or excluding flow-limiting CAD was 0.87 [95% confidence interval (CI): 0.84-0.91]. In patients without prior myocardial infarction, the AUC was 0.90 (95% CI: 0.87-0.94) and in patients without prior CAD the AUC for combined CTA-CTP was 0.93 (95% CI: 0.89-0.97). For the combination of a CTA stenosis ≥50% stenosis and a CTP perfusion deficit, the sensitivity, specificity, positive predictive, and negative predicative values (95% CI) were 80% (72-86), 74% (68-80), 65% (58-72), and 86% (80-90), respectively. For flow-limiting disease defined by ICA-SPECT/MPI, the accuracy of CTA was significantly increased by the addition of CTP at both the patient and vessel levels. CONCLUSIONS: The combination of CTA and perfusion correctly identifies patients with flow limiting CAD defined as ≥50 stenosis by ICA causing a perfusion defect by SPECT/MPI.
European Heart Journal, 2014, Vol 35, Issue 17, p. 1120-30