Incremental Prognostic Value of Myocardial Blood Flow Quantified With Stress Dynamic Computed Tomography Perfusion Imaging

• Material Type: 博士論文
• Title: Incremental Prognostic Value of Myocardial Blood Flow Quantified With Stress Dynamic Computed Tomography Perfusion Imaging
• Author/Editor: Nakamura, Satoshi
• Author Heading: Nakamura, Satoshi
• Publication, Distribution, etc.: 三重大学
• Publication Date: 2021-03-25
• Publication Date (W3CDTF): 2021-03-25
• Degree grantor/type: 三重大学
• Date Granted: 2021-03-25
• Date Granted (W3CDTF): 2021-03-25
• Dissertation Number: 甲医学第2063号
• Degree Type: 博士(医学)
• Conferring No. (Dissertation): 甲医学第2063号
• Text Language Code: eng
• Alias of Author: ナカムラ, サトシ; 中村, 哲士
• Subject Heading: coronary artery disease; coronary CT angiography; dynamic CT perfusion
• Target Audience: 一般
• Note (General): application/pdf; OBJECTIVES This study aimed to evaluate whether myocardial blood flow (MBF) quantified with dynamic computed tomography perfusion imaging (CTP) has an incremental prognostic value over coronary CT angiography (CTA) for major adverse cardiac events (MACEs) in patients with suspected coronary artery disease (CAD).BACKGROUND The incremental prognostic value of CTP over CTA is unclear. The quantification of MBF with dynamic CTP may potentially enhance risk stratification.METHODS A total of 332 patients (67% men; age: 67 ± 10 years) with suspected CAD who underwent CTA and dynamic CTP was analyzed. A MACE was defined as cardiac death, nonfatal myocardial infarction (MI), unstable angina, or hospitalization for congestive heart failure. A summed stress score (SSS) was calculated by adding scores of all myocardial segments according to normalized MBF values. Abnormal perfusion was defined as SSS≧4. Obstructive CAD was defined as≧50% stenosis in≧1 vessel on CTA.RESULTS During a median follow-up of 2.5 years, 19 patients had a MACE. Multivariate analysis showed that, when adjusted for obstructive CAD on CTA, abnormal perfusion was significantly associated with hazards for MACEs(hazard ratio [HR]: 5.7; 95% confidence interval [CI]: 1.9 to 16.9; p . 0.002), with a significant improvement in the prognostic value. Abnormal perfusion was an independent predictor even when adjusted for≧70% stenosis in≧1 vessel(HR: 5.4; 95% CI: 1.7 to 16.7; p=0.003) or adjusted for ≧50% stenosis in≧2 vessels (HR: 6.5; 95% CI: 2.2 to 18.9; p=0.001). In the setting of obstructive CAD, annualized event rates showed a significant difference between the patients with and without abnormal perfusion for all events (12.2% vs. 1.5%; p=0.002) and for cardiac death and nonfatal MI (4.2% vs. 0%; p=0.015).CONCLUSIONS MBF quantified with dynamic CTP has an incremental prognostic value over CTA. The addition of dynamic CTP to CTA allows improved risk stratification of patients with CTA-detected stenosis. (J Am Coll Cardiol Img 2019;12:1379–87) © 2019 by the American College of Cardiology Foundation.; 本文/Department of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan; 9p
• DOI: info:doi/10.1016/j.jcmg.2018.05.021; https://doi.org/info:doi/10.1016/j.jcmg.2018.05.021
• Persistent ID (NDL): info:ndljp/pid/11711066; https://dl.ndl.go.jp/pid/11711066
• Collection: 障害者向け資料
• Collection (Materials For Handicapped People:1): テキストデータ
• Collection (particular): 国立国会図書館デジタルコレクション > デジタル化資料 > 博士論文; https://dl.ndl.go.jp/collections/A00014
• Acquisition Basis: 博士論文（自動収集）
• Date Accepted (W3CDTF): 2021-08-09T17:15:52+09:00
• Date Created (W3CDTF): 2021-06-29
• Format (IMT): application/pdf
• Access Restrictions: 国立国会図書館内限定公開
• Service for the Digitized Contents Transmission Service: 図書館・個人送信対象外
• Availability of remote photoduplication service: 可
• Periodical Title (URI): http://hdl.handle.net/10076/00019692; https://mie-u.repo.nii.ac.jp/records/14074
• Data Provider (Database): 国立国会図書館 : 国立国会図書館デジタルコレクション; https://dl.ndl.go.jp