Role of computed tomographic dynamic myocardial perfusion in the diagnosis of functional significance of coronary artery stenosis


DOI: https://dx.doi.org/10.18565/therapy.2024.6.112-121

Dmitrieva D.S., Filatova D.A., Pavlikova E.P., Krasnova T.N., Mershina E.A., Lisitskaya M.V., Trukhanova M.A., Seredenina E.M., Vaipan D.V., Polyakov R.S., Vartanyan E.L., Sinitsyn V.E.

M.V. Lomonosov Moscow State University
Abstract. The presented clinical case demonstrates the use of computed tomographic (CT) angiography for assessment of myocardial perfusion in a comorbid patient with coronary heart disease. According to non-invasive tests data, the patient had borderline stenosis (70%) in the right coronary artery. Estimation the functional significance of stenosis in this case was complicated, because due to comorbidity, in particular the presence of chronic obstructive pulmonary disease (COPD), patient experienced difficulties in performing standard stress tests; in addition, their results were not informative, since shortness of breath could be not only the equivalent of ischemia, but also a manifestation of COPD. Methodic of cardiac CT with pharmacological stress myocardial perfusion assessment made it possible to verify myocardial ischemia, and its results were comparable to the data of invasive coronary angiography. Article discusses the prospects for using CT coronary angiography with myocardial perfusion assessment in clinical practice.
Keywords: computed tomographic angiography, myocardial stress perfusion, shortness of breath, adenosine triphosphate, chronic obstructive pulmonary disease, coronary heart disease
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Literature

1. Барбараш О.Л., Карпов Ю.А., Кашталап В.В. с соавт. Стабильная ишемическая болезнь сердца. Клинические рекомендации 2020. Российский кардиологический журнал. 2020; 25(11): 201–250. (Barbarash O.L., Karpov Yu.A., Kashtalap V.V. et al. 2020 Clinical practice guidelines for Stable coronary artery disease. Rossijskiy kardiologicheskij zhurnal = Russian Journal of Cardiology. 2020; 25(11): 201–250 (In Russ.)).


https://doi.org/10.15829/1560-4071-2020-4076. EDN: THCMQS.


2. Карпов Ю.А., Кухарчук В.В., Лякишев А.А. с соавт. Диагностика и лечение хронической ишемической болезни сердца. Кардиологический вестник. 2015; 10(3): 3–33. (Karpov Yu.A., Kukharchuk V.V., Lyakishev A.A. et al. Diagnosis and treatment of chronic ischemic heart disease. Kardiologicheskiy vestnik = Cardiology Bulletin. 2015; 10(3): 3–33 (In Russ.)). EDN: UKKHIJ.


3. Knuuti J., Ballo H., Juarez-Orozco L.E. et al. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: A meta-analysis focused on post-test disease probability. Eur Heart J. 2018; 39(35): 3322–30.


https://doi.org/10.1093/eurheartj/ehy267. PMID: 29850808.


4. Hoffmann U., Ferencik M., Udelson J.E. et al. Prognostic value of noninvasive cardiovascular testing in patients with stable chest pain: Insights from the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation. 2017; 135(24): 2320–32.


https://doi.org/10.1161/circulationaha.116.024360. PMID: 28389572. PMCID: PMC5946057.


5. Knuuti J., Wijns W., Saraste A. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020; 41(3): 407–77.


https://doi.org/10.1093/eurheartj/ehz425. PMID: 31504439.


6. García-Baizan A., Millor M., Bartolome P. et al. Adenosine triphosphate (ATP) and adenosine cause similar vasodilator effect in patients undergoing stress perfusion cardiac magnetic resonance imaging. Int J Cardiovasc Imaging. 2019; 35(4): 675–82.


https://doi.org/10.1007/s10554-018-1494-y. PMID: 30426300.


7. Чучалин А.Г., Авдеев С.Н., Айсанов З.Р. с соавт. Хроническая обструктивная болезнь легких: федеральные клинические рекомендации по диагностике и лечению. Пульмонология. 2022; 32(3): 356–392. (Chuchalin A.G., Avdeev S.N., Aisanov Z.R. et al. Federal guidelines on diagnosis and treatment of chronic obstructive pulmonary disease. Pulmonologiya = Pulmonology. 2022; 32(3): 356–392 (In Russ.)).


https://doi.org/10.18093/0869-0189-2022-32-3-356-392. EDN: ANYVUN.


8. Верткин А.Л., Скотников А.С., Тихоновская Е.Ю. с соавт. Коморбидность при ХОБЛ: роль хронического системного воспаления. РМЖ. 2014; 22(11): 811–816. (Vertkin A.L., Skotnikov A.S., Tikhonovskaya E.Yu. et al. Comorbidity in patients with chronic obstructive lung disease: the role of chronic systemic inflammation. Russkiy meditsinskiy zhurnal = Russian Medical Journal. 2014; 22(11): 811–816 (In Russ.)). EDN: SKBNMF.


9. Greenwood J.P., Ripley D.P., Berry C. et al. Effect of care guided by cardiovascular magnetic resonance, myocardial perfusion scintigraphy, or NICE guidelines on subsequent unnecessary angiography rates: The CE-MARC 2 randomized clinical trial. JAMA. 2016; 316(10): 1051–60.


https://doi.org/10.1001/jama.2016.12680. PMID: 27570866.


10. Siontis G.C., Mavridis D., Greenwood J.P. et al. Outcomes of non-invasive diagnostic modalities for the detection of coronary artery disease: Network meta-analysis of diagnostic randomised controlled trials. BMJ. 2018; 360: k504.


https://doi.org/10.1136/bmj.k504. PMID: 29467161. PMCID: PMC5820645.


11. Wang Y., Qin L., Shi X. et al. Adenosine-stress dynamic myocardial perfusion imaging with second-generation dual-source CT: Comparison with conventional catheter coronary angiography and SPECT nuclear myocardial perfusion imaging. AJR Am J Roentgenol. 2012; 198(3): 521–29.


https://doi.org/10.2214/AJR.11.7830. PMID: 22357991.


12. Tomizawa N., Chou S., Fujino Y. et al. Feasibility of dynamic myocardial CT perfusion using single-source 64-row CT. J Cardiovasc Comput Tomogr. 2019; 13(1): 55–61.


https://doi.org/10.1016/j.jcct.2018.10.003. PMID: 30309765.


13. Seitun S., Castiglione Morelli M., Budaj I. et al. Stress computed tomography myocardial perfusion imaging: A new topic in cardiology. Rev Esp Cardiol. 2016; 69(2): 188–200.


https://doi.org/10.1016/j.rec.2015.10.018. PMID: 26774540.


14. Danad I., Szymonifka J., Schulman-Marcus J. et al. Static and dynamic assessment of myocardial perfusion by computed tomography. Eur Heart J Cardiovasc Imaging. 2016; 17(8): 836–44.


https://doi.org/10.1093/ehjci/jew044. PMID: 27013250. PMCID: PMC4955293.


15. Meinel F.G., Ebersberger U., Schoepf U.J. et al. Global quantification of left ventricular myocardial perfusion at dynamic CT: Feasibility in a multicenter patient population. AJR Am J Roentgenol. 2014; 203(2): W174–80.


https://doi.org/10.2214/ajr.13.12328. PMID: 24848691.


16. Huber A.M., Leber V., Gramer B.M. et al. Myocardium: Dynamic versus single-shot CT perfusion imaging. Radiology. 2013;269(2): 378–86.


https://doi.org/10.1148/radiology.13121441. PMID: 23788717.


About the Autors

Daria S. Dmitrieva, MD, 2nd year resident doctor of the Department of internal medicine of Medical Research and Educational Center, M.V. Lomonosov Moscow State University. Address: Moscow, 27 build. 10 Lomonosovsky Avenue.
E-mail: Sergeevna_D9@mail.ru
ORCID: https://orcid.org/0009-0002-0748-0273
Daria A. Filatova, MD, postgraduate student of the Department of radiation diagnostics and therapy, M.V. Lomonosov Moscow State University, radiologist at the Department of X-ray diagnostics with MRI and CT rooms of Research and Educational Center of M.V. Lomonosov Moscow State University. Address: Moscow, 27 build. 10 Lomonosovsky Avenue.
E-mail: dariafilatova.msu@mail.ru
ORCID: https://orcid.org/0000-0002-0894-1994
Elena P. Pavlikova, MD, Dr. Sci (Medicine), professor of the Department of internal medicine of the Faculty of fundamental medicine, M.V. Lomonosov Moscow State University, deputy director for clinical work, chief physician of the Medical Research and Educational Center, M.V. Lomonosov Moscow State University. Address: Moscow, 27 build. 10 Lomonosovsky Avenue.
E-mail: elena.pavlikova@inbox.ru
ORCID: https://orcid.org/0000-0001-7693-5281
Tatyana N. Krasnova, MD, PhD (Medicine), head of the Department of internal diseases of the Faculty of fundamental medicine, M.V. Lomonosov Moscow State University, leading researcher at the Department of internal diseases of the Medical Research and Educational Center, M.V. Lomonosov Moscow State University. Address: Moscow, 27 build. 10 Lomonosovsky Avenue.
E-mail: krasnovamgu@yandex.ru
ORCID: https://orcid.org/0000-0001-6175-1076
Elena A. Mershina, MD, PhD (Medicine), associate professor of the Department of radiation diagnostics and therapy, M.V. Lomonosov Moscow State University, head of the Department of X-ray diagnostics with MRI and CT rooms at the Medical Research and Educational Center, M.V. Lomonosov Moscow State University. Address: Moscow, 27 build. 10 Lomonosovsky Avenue.
E-mail: elena_mershina@mail.ru
ORCID: https://orcid.org/0000-0002-1266-4926
Maria V. Lisitskaya, MD, PhD (Medicine), radiologist at the Department of X-ray diagnostics with MRI and CT rooms at the Medical Research and Educational Center, M.V. Lomonosov Moscow State University. Address: Moscow, 27 build. 10 Lomonosovsky Avenue.
ORCID: https://orcid.org/0000-0002-8402-7643
Maria A. Trukhanova, MD, PhD (Medicine), anesthesiologist-resuscitator, researcher at the Department of internal medicine of the Medical Research and Educational Center, M.V. Lomonosov Moscow State University. Address: Moscow, 27 build. 10 Lomonosovsky Avenue.
E-mail: tryxanova@yandex.ru
ORCID: https://orcid.org/0000-0002-9957-4906
Elena M. Seredenina, MD, PhD (Medicine), head of the Department of therapy, senior researcher at the Department of age-associated diseases of the Medical Research and Educational Center, M.V. Lomonosov Moscow State University. Address: Moscow, 27 build. 10 Lomonosovsky Avenue.
E-mail: e.m.seredenina@gmail.com
ORCID: https://orcid.org/0000-0002-1490-2078
Daniil V. Vaypan, MD, general practitioner, researcher at the Department of internal diseases of the Medical Research and Educational Center, M.V. Lomonosov Moscow State University, assistant at the Department of internal medicine of the Faculty of fundamental medicine, M.V. Lomonosov Moscow State University. Address: Moscow, 27 build. 10 Lomonosovsky Avenue.
E-mail: vdv_zao@mail.ru
Roman S. Polyakov, MD, Dr. Sci. (Medicine), head of the Department of X-ray surgical methods of diagnostics and treatment of the Medical Research and Educational Center, M.V. Lomonosov Moscow State University. Address: Moscow, 27 build. 10 Lomonosovsky Avenue.
E-mail: Roman.polyakov@gmail.com
ORCID: https://orcid.org/0000-0002-9323-4003
Erik L. Vartanyan, MD, PhD (Medicine), doctor for X-ray endovascular diagnostics and treatment of the Medical Research and Educational Center, M.V. Lomonosov Moscow State University. Address: Moscow, 27 build. 10 Lomonosovsky Avenue.
ORCID: https://orcid.org/0000-0001-6757-7101
Valentin E. Sinitsyn, MD, Dr. Sci. (Medicine), professor, head of the Department of radiation diagnostics of the Medical Research and Educational Center, M.V. Lomonosov Moscow State University, head of the Department of radiation diagnostics and therapy of the Faculty of fundamental medicine, M.V. Lomonosov Moscow State University. Address: Moscow, 27 build. 10 Lomonosovsky Avenue.
E-mail: vsini@mail.ru
ORCID: https://orcid.org/0000-0002-5649-2193


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