- Email: [email protected]
Multidetector Computed Tomography Stress-Rest Perfusion Imaging for Detection of Coronary Artery Disease
Accepted Manuscript Letter to the Editor: Multidetector Computed Tomography Stress-Rest Perfusion Imaging for Detection of Coronary Artery Disease Abhishek Sharma, MD PII:
S0735-1097(13)01950-5
DOI:
10.1016/j.jacc.2013.03.077
Reference:
JAC 18902
To appear in:
Journal of the American College of Cardiology
Received Date: 28 February 2013 Accepted Date: 5 March 2013
Please cite this article as: Sharma A, Letter to the Editor: Multidetector Computed Tomography StressRest Perfusion Imaging for Detection of Coronary Artery Disease, Journal of the American College of Cardiology (2013), doi: 10.1016/j.jacc.2013.03.077. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Letter to the Editor: Multidetector Computed Tomography Stress-Rest Perfusion Imaging for Detection of Coronary Artery Disease
Corresponding Author Abhishek Sharma, MD
Word Count: 262
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EP
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Disclosure: No conflict of interest
M AN U
Maimonides Medical Center, NY Postal address: 1016 50th street Apt 2C Brooklyn, NY 11219 Phone# 201-892-6548 Email: [email protected]
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Author: Abhishek Sharma MD
1
ACCEPTED MANUSCRIPT
Bettencourt and colleagues compare the diagnostic performance of multidetector computed tomography (MDCT) stress- rest perfusion imaging (using significantly lower dose radiation) with cardiac magnetic resonance myocardial perfusion imaging (CMR-Perf) for detection of
RI PT
functionally significant coronary artery disease (CAD) with fractional flow reserve (FFR) as reference standard [1].
It would be interesting to know- 1) if authors made an attempt to compare performance of CTP
SC
and CMR-Per among patients with multi vessel disease or those with >70% stenosis. 2)-Did
M AN U
authors made an attempt to investigate the lesions labeled ‘false positive’ on CTP-which could be incorrectly labeled as ‘false positive’ in setting of non obstructive coronaries (due to thrombus recannalization or post PCI). Authors measures FFR in vessels with >40% stenosis; however, abnormal FFR can be found in vessels with lesser degree of stenosis [2]. This is more important in setting of microvascular disease-which have worse prognosis. CTP could be particularly
TE D
helpful in such scenario due its high resolution and ability to evaluate parameters of endothelial function and microvascular circulation [3].
EP
Though, use of 17 segment model to compare CTP and CMR-Perf is itself not perfect, due to overlap of segments between various coronary territories; current report is a welcome step in the
AC C
ongoing search for “one stop” cardiac imaging modality. However, an important practical limitation of CTP at this time is need for designated software for image analyses and substantial expertise to interpret images and make accurate diagnoses. Further, as patient population in current study was very selective- it would be interesting to see in future studies -how MDCT-IP performs in ‘real world’.
2
ACCEPTED MANUSCRIPT
References: 1. Bettencourt N, Chiribiri A, Schuster A, et al. Direct Comparison of Cardiac Magnetic
Detection of Coronary Artery Disease. J Am Coll Cardiol. 2013;():. doi:10.1016/j.jacc.2012.12.020.
RI PT
Resonance and Multidetector Computed Tomography Stress-Rest Perfusion Imaging for
SC
2. Ko BS, Cameron JD, Meredith IT, et al. Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve.
M AN U
Eur Heart J. 2012 Jan;33(1):67-77.
3. Daghini E, Primak AN, Chade AR, et al. Evaluation of porcine myocardial microvascular permeability and fractional vascular volume using 64-slice helical computed tomography (CT).
AC C
EP
TE D
Invest Radiol 2007;42(5): 274-282.
3
S0735-1097(13)01950-5
DOI:
10.1016/j.jacc.2013.03.077
Reference:
JAC 18902
To appear in:
Journal of the American College of Cardiology
Received Date: 28 February 2013 Accepted Date: 5 March 2013
Please cite this article as: Sharma A, Letter to the Editor: Multidetector Computed Tomography StressRest Perfusion Imaging for Detection of Coronary Artery Disease, Journal of the American College of Cardiology (2013), doi: 10.1016/j.jacc.2013.03.077. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Letter to the Editor: Multidetector Computed Tomography Stress-Rest Perfusion Imaging for Detection of Coronary Artery Disease
Corresponding Author Abhishek Sharma, MD
Word Count: 262
AC C
EP
TE D
Disclosure: No conflict of interest
M AN U
Maimonides Medical Center, NY Postal address: 1016 50th street Apt 2C Brooklyn, NY 11219 Phone# 201-892-6548 Email: [email protected]
SC
RI PT
Author: Abhishek Sharma MD
1
ACCEPTED MANUSCRIPT
Bettencourt and colleagues compare the diagnostic performance of multidetector computed tomography (MDCT) stress- rest perfusion imaging (using significantly lower dose radiation) with cardiac magnetic resonance myocardial perfusion imaging (CMR-Perf) for detection of
RI PT
functionally significant coronary artery disease (CAD) with fractional flow reserve (FFR) as reference standard [1].
It would be interesting to know- 1) if authors made an attempt to compare performance of CTP
SC
and CMR-Per among patients with multi vessel disease or those with >70% stenosis. 2)-Did
M AN U
authors made an attempt to investigate the lesions labeled ‘false positive’ on CTP-which could be incorrectly labeled as ‘false positive’ in setting of non obstructive coronaries (due to thrombus recannalization or post PCI). Authors measures FFR in vessels with >40% stenosis; however, abnormal FFR can be found in vessels with lesser degree of stenosis [2]. This is more important in setting of microvascular disease-which have worse prognosis. CTP could be particularly
TE D
helpful in such scenario due its high resolution and ability to evaluate parameters of endothelial function and microvascular circulation [3].
EP
Though, use of 17 segment model to compare CTP and CMR-Perf is itself not perfect, due to overlap of segments between various coronary territories; current report is a welcome step in the
AC C
ongoing search for “one stop” cardiac imaging modality. However, an important practical limitation of CTP at this time is need for designated software for image analyses and substantial expertise to interpret images and make accurate diagnoses. Further, as patient population in current study was very selective- it would be interesting to see in future studies -how MDCT-IP performs in ‘real world’.
2
ACCEPTED MANUSCRIPT
References: 1. Bettencourt N, Chiribiri A, Schuster A, et al. Direct Comparison of Cardiac Magnetic
Detection of Coronary Artery Disease. J Am Coll Cardiol. 2013;():. doi:10.1016/j.jacc.2012.12.020.
RI PT
Resonance and Multidetector Computed Tomography Stress-Rest Perfusion Imaging for
SC
2. Ko BS, Cameron JD, Meredith IT, et al. Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve.
M AN U
Eur Heart J. 2012 Jan;33(1):67-77.
3. Daghini E, Primak AN, Chade AR, et al. Evaluation of porcine myocardial microvascular permeability and fractional vascular volume using 64-slice helical computed tomography (CT).
AC C
EP
TE D
Invest Radiol 2007;42(5): 274-282.
3