The Korean journal of internal medicine

  • 제32권5호
  • /
  • Pages.847-854
  • /
  • 2017
  • /
  • 1226-3303(pISSN)
  • /
  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

Geographic and demographic variabilities of quantitative parameters in stress myocardial computed tomography perfusion

  • Park, Jinoh (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Hyun-Sook (Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital) ;
  • Hwang, Hye Jeon (Department of Radiology, Hallym University Sacred Heart Hospital) ;
  • Yang, Dong Hyun (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koo, Hyun Jung (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kang, Joon-Won (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young-Hak (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2016.01.04
  • 심사 : 2016.01.22
  • 발행 : 2017.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: To evaluate the geographic and demographic variabilities of the quantitative parameters of computed tomography perfusion (CTP) of the left ventricular (LV) myocardium in patients with normal coronary artery on computed tomography angiography (CTA). Methods: From a multicenter CTP registry of stress and static computed tomography, we retrospectively recruited 113 patients (mean age, 60 years; 57 men) without perfusion defect on visual assessment and minimal (< 20% of diameter stenosis) or no coronary artery disease on CTA. Using semiautomatic analysis software, quantitative parameters of the LV myocardium, including the myocardial attenuation in stress and rest phases, transmural perfusion ratio (TPR), and myocardial perfusion reserve index (MPRI), were evaluated in 16 myocardial segments. Results: In the lateral wall of the LV myocardium, all quantitative parameters except for MPRI were significantly higher compared with those in the other walls. The MPRI showed consistent values in all myocardial walls (anterior to lateral wall: range, 25% to 27%; p = 0.401). At the basal level of the myocardium, all quantitative parameters were significantly lower than those at the mid- and apical levels. Compared with men, women had significantly higher values of myocardial attenuation and TPR. Age, body mass index, and Framingham risk score were significantly associated with the difference in myocardial attenuation. Conclusions: Geographic and demographic variabilities of quantitative parameters in stress myocardial CTP exist in healthy subjects without significant coronary artery disease. This information may be helpful when assessing myocardial perfusion defects in CTP.

키워드

참고문헌

  1. Kim YH, Ahn JM, Park DW, et al. Impact of ischemia-guided revascularization with myocardial perfusion imaging for patients with multivessel coronary disease. J Am Coll Cardiol 2012;60:181-190. https://doi.org/10.1016/j.jacc.2012.02.061
  2. Fearon WF. Physiologic approach for coronary intervention. Korean J Intern Med 2013;28:1-7. https://doi.org/10.3904/kjim.2013.28.1.1
  3. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 2003;107:2900-2907. https://doi.org/10.1161/01.CIR.0000072790.23090.41
  4. Ko BS, Cameron JD, Meredith IT, et al. Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve. Eur Heart J 2012;33:67-77. https://doi.org/10.1093/eurheartj/ehr268
  5. Ko BS, Cameron JD, Leung M, et al. Combined CT coronary angiography and stress myocardial perfusion imaging for hemodynamically significant stenoses in patients with suspected coronary artery disease: a comparison with fractional flow reserve. JACC Cardiovasc Imaging 2012;5:1097-1111. https://doi.org/10.1016/j.jcmg.2012.09.004
  6. George RT, Arbab-Zadeh A, Miller JM, et al. Adenosine stress 64- and 256-row detector computed tomography angiography and perfusion imaging: a pilot study evaluating the transmural extent of perfusion abnormalities to predict atherosclerosis causing myocardial ischemia. Circ Cardiovasc Imaging 2009;2:174-182. https://doi.org/10.1161/CIRCIMAGING.108.813766
  7. Cury RC, Magalhaes TA, Paladino AT, et al. Dipyridamole stress and rest transmural myocardial perfusion ratio evaluation by 64 detector-row computed tomography. J Cardiovasc Comput Tomogr 2011;5:443-448. https://doi.org/10.1016/j.jcct.2011.10.012
  8. Kitagawa K, George RT, Arbab-Zadeh A, Lima JA, Lardo AC. Characterization and correction of beam-hardening artifacts during dynamic volume CT assessment of myocardial perfusion. Radiology 2010;256:111-118. https://doi.org/10.1148/radiol.10091399
  9. Stanton CL, Haramati LB, Berko NS, et al. Normal myocardial perfusion on 64-detector resting cardiac CT. J Cardiovasc Comput Tomogr 2011;5:52-60. https://doi.org/10.1016/j.jcct.2010.11.003
  10. Byrne C, Kuhl JT, Zacho M, et al. Sex- and age-related differences of myocardial perfusion at rest assessed with multidetector computed tomography. J Cardiovasc Comput Tomogr 2013;7:94-101. https://doi.org/10.1016/j.jcct.2013.01.010
  11. Rodriguez-Granillo GA, Rosales MA, Degrossi E, Rodriguez AE. Signal density of left ventricular myocardial segments and impact of beam hardening artifact: implications for myocardial perfusion assessment by multidetector CT coronary angiography. Int J Cardiovasc Imaging 2010;26:345-354.
  12. Crossett MP, Schneider-Kolsky M, Troupis J. Normal perfusion of the left ventricular myocardium using 320 MDCT. J Cardiovasc Comput Tomogr 2011;5:406-411. https://doi.org/10.1016/j.jcct.2011.10.003
  13. Vaccarino V, Badimon L, Corti R, et al. Ischaemic heart disease in women: are there sex differences in pathophysiology and risk factors? Position paper from the working group on coronary pathophysiology and microcirculation of the European Society of Cardiology. Cardiovasc Res 2011;90:9-17. https://doi.org/10.1093/cvr/cvq394
  14. Mendelsohn ME, Karas RH. The protective effects of estrogen on the cardiovascular system. N Engl J Med 1999;340:1801-1811. https://doi.org/10.1056/NEJM199906103402306
  15. Bae KT, Seeck BA, Hildebolt CF, et al. Contrast enhancement in cardiovascular MDCT: effect of body weight, height, body surface area, body mass index, and obesity. AJR Am J Roentgenol 2008;190:777-784. https://doi.org/10.2214/AJR.07.2765
  16. Cullen JH, Horsfield MA, Reek CR, Cherryman GR, Barnett DB, Samani NJ. A myocardial perfusion reserve index in humans using first-pass contrast-enhanced magnetic resonance imaging. J Am Coll Cardiol 1999;33:1386-1394. https://doi.org/10.1016/S0735-1097(99)00004-2