PDF(Pubmed)
Abstract：
BACKGROUND: Chronic limb-threatening ischemia (CLTI) is associated with high rates of long-term cardiovascular mortality. Exercise stress testing to detect obstructive coronary artery disease (CAD) can be difficult in this subset of patients due to inability to undergo exercise testing, presence of balanced ischemia and severe coronary artery calcification (CAC).
OBJECTIVE: To test the feasibility of regadenoson stress dynamic perfusion computed tomography (DPCT) in CLTI patients.
METHODS: Between 2018 and 2023, coronary computed tomography angiography (CTA) and, in the case of a calcium score higher than 400, DPCT, were performed in 25 CLTI patients with a history of endovascular revascularization.
RESULTS: Of the 25 patients, 19 had a calcium score higher than 400, requiring DPCT image acquisition. Obstructive CAD could be ruled out in 10 of the 25 patients. Of the 15 CTA/DPCT+ patients, 13 proceeded to coronary angiography (CAG). Revascularization was necessary in all 13 patients. In these 13 patients, vessel-based sensitivity and specificity of coronary CTA/DPCT as compared to invasive evaluation was 75%, respectively. At follow-up (27 ± 21 months) there was no statistically significant difference in all-cause mortality between CTA/DPCT- positive and -negative patients (p = 0.065).
CONCLUSIONS: Despite a high prevalence of severe CAC, coronary CTA complemented by DPCT may be a feasible method to detect obstructive and functionally significant CAD in CLTI patients.
OBJECTIVE: To test the feasibility of regadenoson stress dynamic perfusion computed tomography (DPCT) in CLTI patients.
METHODS: Between 2018 and 2023, coronary computed tomography angiography (CTA) and, in the case of a calcium score higher than 400, DPCT, were performed in 25 CLTI patients with a history of endovascular revascularization.
RESULTS: Of the 25 patients, 19 had a calcium score higher than 400, requiring DPCT image acquisition. Obstructive CAD could be ruled out in 10 of the 25 patients. Of the 15 CTA/DPCT+ patients, 13 proceeded to coronary angiography (CAG). Revascularization was necessary in all 13 patients. In these 13 patients, vessel-based sensitivity and specificity of coronary CTA/DPCT as compared to invasive evaluation was 75%, respectively. At follow-up (27 ± 21 months) there was no statistically significant difference in all-cause mortality between CTA/DPCT- positive and -negative patients (p = 0.065).
CONCLUSIONS: Despite a high prevalence of severe CAC, coronary CTA complemented by DPCT may be a feasible method to detect obstructive and functionally significant CAD in CLTI patients.
摘要：
背景：慢性威胁肢体缺血（CLTI）与长期心血管死亡率高相关。在这部分患者中，由于无法进行运动测试，检测阻塞性冠状动脉疾病（CAD）的运动压力测试可能很困难。存在平衡的缺血和严重的冠状动脉钙化（CAC）。
目的：验证在CLTI患者中应用regadenoson应力动态灌注CT（DPCT）的可行性。
方法：在2018年至2023年之间，冠状动脉计算机断层扫描血管造影（CTA）和，在钙评分高于400的情况下，DPCT，在25例有血管内血运重建史的CLTI患者中进行。
结果：在25名患者中，19具有高于400的钙评分,需要DPCT图像采集。25例患者中有10例可以排除阻塞性CAD。15例CTA/DPCT+患者中,13进行冠状动脉造影（CAG）。所有13例患者都需要进行血运重建。在这13名患者中，冠状动脉CTA/DPCT的血管敏感性和特异性与侵入性评估相比为75%,分别。在随访（27±21个月）时，CTA/DPCT阳性和阴性患者的全因死亡率无统计学差异（p=0.065）。
结论：尽管严重CAC的患病率很高，DPCT补充冠状动脉CTA可能是检测CLTI患者阻塞性和功能显著CAD的可行方法.
目的：验证在CLTI患者中应用regadenoson应力动态灌注CT（DPCT）的可行性。
方法：在2018年至2023年之间，冠状动脉计算机断层扫描血管造影（CTA）和，在钙评分高于400的情况下，DPCT，在25例有血管内血运重建史的CLTI患者中进行。
结果：在25名患者中，19具有高于400的钙评分,需要DPCT图像采集。25例患者中有10例可以排除阻塞性CAD。15例CTA/DPCT+患者中,13进行冠状动脉造影（CAG）。所有13例患者都需要进行血运重建。在这13名患者中，冠状动脉CTA/DPCT的血管敏感性和特异性与侵入性评估相比为75%,分别。在随访（27±21个月）时，CTA/DPCT阳性和阴性患者的全因死亡率无统计学差异（p=0.065）。
结论：尽管严重CAC的患病率很高，DPCT补充冠状动脉CTA可能是检测CLTI患者阻塞性和功能显著CAD的可行方法.
