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Imaging modality may detect abnormal resting coronary blood flow
Chow B. J Am Coll Cardiol. 2011;57:1280–1288.
Rybicki F. J Am Coll Cardiol. 2011;57:1289-1290.
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Changes in corrected coronary opacification within the coronary lumen detected by computed tomographic coronary angiography were predictive of abnormal resting coronary blood flow, suggested a new study.
The Canadian researchers conducted this proof-of-concept study by assessing 104 coronary arteries from 52 patients (mean age, 60 ± 9.5 years) via computed tomographic coronary angiography (CTA). All patients were without a history of revascularization, congenital heart disease and heart transplantation, and had obstructive CAD in at least one vessel and at least one major epicardial vessel for use as a “normal” reference artery.
According to data, differences in corrected coronary opacification (CCO) were greater in arteries with CTA diameter stenoses ≥ 50%, as were the CCO differences in arteries with thrombolysis in MI flow grade ≤3 (0.406 ± 0.226) vs. TIMI flow grade 3 (0.078 ± 0.078; P<.001). With regard to CCO differences, CTA detected abnormal coronary flow (TIMI flow grade <3) with a sensitivity of 83.3%, specificity of 91.2%, accuracy of 88.5%, positive predictive value of 83.3% and negative predictive value of 91.2%.
“The ability of CTA to estimate coronary blood flow and to assess for functional coronary stenosis would be extremely desirable,” the researchers wrote of their findings. “Such a technique might prove to be useful in settings of unevaluable coronary segments, perhaps by improving the diagnostic accuracy of CTA. Equally important would be its potential applicators to measure stress coronary blood flow, thus permitting the assessment of hemodynamic significance of a lesion.”
Frank J. Rybicki, MD, PhD, with the Brigham and Women’s Hospital and Harvard Medical School, Boston, commented in an accompanying editorial that “Coronary imaging will define the next generation of ‘state-of-the-art’ in CT, and future generations of hardware technology are likely to change the way we think about image acquisition. While we collectively study these gains and new applications, it is essential to recognize, optimize and study the properties of coronary artery enhancement to maximize our understanding of CT angiography and optimally use it for patient care.”
Disclosure: Dr. Rybicki has received research grants from Toshiba Medical Systems Corporation, Bracco Diagnostics and Vital Images.
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