Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: The CORE320 study

Carlos E. Rochitte, Richard T. George, Marcus Y. Chen, Armin Arbab-Zadeh, Marc Dewey, Julie M. Miller, Hiroyuki Niinuma, Kunihiro Yoshioka, Kakuya Kitagawa, Shiro Nakamori, Roger Laham, Andrea L. Vavere, Rodrigo J. Cerci, Vishal C. Mehra, Cesar Nomura, Klaus F. Kofoed, Masahiro Jinzaki, Sachio Kuribayashi, Albert De Roos, Michael LauleSwee Yaw Tan, John Hoe, Narinder Paul, Frank J. Rybicki, Jeffery A. Brinker, Andrew E. Arai, Christopher Cox, Melvin E. Clouse, Marcelo F. Di Carli, Joao A C Lima

Research output: Contribution to journalArticle

236 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1120-1130
Number of pages11
JournalEuropean Heart Journal
Volume35
Issue number17
DOIs
Publication statusPublished - 2014

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Coronary Stenosis
Single-Photon Emission-Computed Tomography
Perfusion
Coronary Angiography
Coronary Artery Disease
Pathologic Constriction
Confidence Intervals
Area Under Curve
Computed Tomography Angiography
ROC Curve
Multicenter Studies
Myocardial Infarction

Keywords

  • Atherosclerosis
  • Imaging
  • Ischemia
  • Multislice computed tomography
  • Perfusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography : The CORE320 study. / Rochitte, Carlos E.; George, Richard T.; Chen, Marcus Y.; Arbab-Zadeh, Armin; Dewey, Marc; Miller, Julie M.; Niinuma, Hiroyuki; Yoshioka, Kunihiro; Kitagawa, Kakuya; Nakamori, Shiro; Laham, Roger; Vavere, Andrea L.; Cerci, Rodrigo J.; Mehra, Vishal C.; Nomura, Cesar; Kofoed, Klaus F.; Jinzaki, Masahiro; Kuribayashi, Sachio; De Roos, Albert; Laule, Michael; Tan, Swee Yaw; Hoe, John; Paul, Narinder; Rybicki, Frank J.; Brinker, Jeffery A.; Arai, Andrew E.; Cox, Christopher; Clouse, Melvin E.; Di Carli, Marcelo F.; Lima, Joao A C.

In: European Heart Journal, Vol. 35, No. 17, 2014, p. 1120-1130.

Research output: Contribution to journalArticle

Rochitte, CE, George, RT, Chen, MY, Arbab-Zadeh, A, Dewey, M, Miller, JM, Niinuma, H, Yoshioka, K, Kitagawa, K, Nakamori, S, Laham, R, Vavere, AL, Cerci, RJ, Mehra, VC, Nomura, C, Kofoed, KF, Jinzaki, M, Kuribayashi, S, De Roos, A, Laule, M, Tan, SY, Hoe, J, Paul, N, Rybicki, FJ, Brinker, JA, Arai, AE, Cox, C, Clouse, ME, Di Carli, MF & Lima, JAC 2014, 'Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: The CORE320 study', European Heart Journal, vol. 35, no. 17, pp. 1120-1130. https://doi.org/10.1093/eurheartj/eht488
Rochitte, Carlos E. ; George, Richard T. ; Chen, Marcus Y. ; Arbab-Zadeh, Armin ; Dewey, Marc ; Miller, Julie M. ; Niinuma, Hiroyuki ; Yoshioka, Kunihiro ; Kitagawa, Kakuya ; Nakamori, Shiro ; Laham, Roger ; Vavere, Andrea L. ; Cerci, Rodrigo J. ; Mehra, Vishal C. ; Nomura, Cesar ; Kofoed, Klaus F. ; Jinzaki, Masahiro ; Kuribayashi, Sachio ; De Roos, Albert ; Laule, Michael ; Tan, Swee Yaw ; Hoe, John ; Paul, Narinder ; Rybicki, Frank J. ; Brinker, Jeffery A. ; Arai, Andrew E. ; Cox, Christopher ; Clouse, Melvin E. ; Di Carli, Marcelo F. ; Lima, Joao A C. / Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography : The CORE320 study. In: European Heart Journal. 2014 ; Vol. 35, No. 17. pp. 1120-1130.
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abstract = "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.",
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TY - JOUR

T1 - Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography

T2 - The CORE320 study

AU - Rochitte, Carlos E.

AU - George, Richard T.

AU - Chen, Marcus Y.

AU - Arbab-Zadeh, Armin

AU - Dewey, Marc

AU - Miller, Julie M.

AU - Niinuma, Hiroyuki

AU - Yoshioka, Kunihiro

AU - Kitagawa, Kakuya

AU - Nakamori, Shiro

AU - Laham, Roger

AU - Vavere, Andrea L.

AU - Cerci, Rodrigo J.

AU - Mehra, Vishal C.

AU - Nomura, Cesar

AU - Kofoed, Klaus F.

AU - Jinzaki, Masahiro

AU - Kuribayashi, Sachio

AU - De Roos, Albert

AU - Laule, Michael

AU - Tan, Swee Yaw

AU - Hoe, John

AU - Paul, Narinder

AU - Rybicki, Frank J.

AU - Brinker, Jeffery A.

AU - Arai, Andrew E.

AU - Cox, Christopher

AU - Clouse, Melvin E.

AU - Di Carli, Marcelo F.

AU - Lima, Joao A C

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

KW - Atherosclerosis

KW - Imaging

KW - Ischemia

KW - Multislice computed tomography

KW - Perfusion

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U2 - 10.1093/eurheartj/eht488

DO - 10.1093/eurheartj/eht488

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