Exploring the clinical profile of patients studied by dynamic myocardial perfusion computed tomography

The use of multidetector computed tomography (MDCT) is becoming increasingly common in patients with intermediate or high pretest risk of coronary artery disease (CAD) or a history of chronic coronary syndrome (CCS). This may reduce its diagnostic accuracy, prompting a greater use of complementary functional imaging tests. Dynamic myocardial perfusion computed tomography (DynCTP) represents a tool capable of providing functional information that complements the anatomical study in a single non-invasive test.

To characterize the baseline characteristics of a cohort of symptomatic patients with suspected CAD (with intermediate to high pretest risk) or a history of CCS examined through MDCT and DynCTP, and to analyze the results of the combination of both techniques.

Prospective and single-center observational study including unselected patients undergoing MDCT followed by DynCTP if CADRADS ≥ 3 or nonconclusive coronary segments were identified between April 2021 and April 2023. Technique outcomes were assessed using a composite of major cardiovascular events (MACE): cardiovascular mortality, acute coronary syndrome (ACS) and the need for revascularization.

A total of 102 patients were included with a mean follow-up of 1.8 ± 0.6 years. Table 1 summarizes their baseline characteristics. DynCTP was performed in 55% of patients, and it was positive in 77% of them. Patients who underwent DynCTP showed higher pretest risk, percentage of previous CCS and atherosclerotic burden. Subjects who underwent both tests received higher radiation doses (532 ± 244 mGy vs. 247 ± 211 mGy; p < 0.01) and contrast volume (112 ± 18 mL vs. 71 ± 4 mL; p < 0.01) than those studied only by MDCT.

DynCTP yielded positive results in 38% of patients with CAD-RADS 3, 88% in cases of CAD-RADS 4 and in all cases of CAD-RADS 5. None of the patients with CAD-RADS less than 3 showed a positive result.

Patients with a positive result in DynCTP had higher atherosclerotic burden measured by CAD-RADS (4.3 ± 0.6 vs. 2.8 ± 0.9), segment involvement score (SIS) (9.1 ± 2.1 vs. 6.4 ± 3.4), and segment stenosis score (SSS) (5 ± 3.5 vs. 10.9 ± 5.9) compared to those with a negative finding (p < 0.01 for all comparisons). No significant differences were observed in the prevalence of cardiovascular risk factors, pretest risk or history of CCS (p > 0.05 for all comparisons).

Patients with a positive DynCTP result underwent more cardiac catheterizations and coronary revascularization procedures, experiencing a higher incidence of MACE compared to those with a negative outcome (see Table 2).

In our population, the patients who underwent DynCTP had a higher pretest probability of CAD, prevalence of CCS and atherosclerotic burden, although only the latter factor was associated with a positive DynCTP. A positive DynCTP study was associated with a higher incidence of cardiac catheterizations, coronary revascularizations, and ACS in the follow-up.

Baseline characteristics of patients