DIAGNOSTIC SIGNIFICANCE OF COMPUTED TOMOGRAPHY IN COMPREHENSIVE

EVALUATION OF CORONARY ARTERIES AND REVERSIBLE MYOCARDIAL ISCHEMIA

IN PATIENTS WITH CHEST PAIN

 

Balahonova A.A.¹, Veselova T.N.¹, Sukhinina T.S.¹, Arutunyan G.K.¹, Shitov V.N.¹,

Merkulova I.N.¹, Ternovoy S.K.^1,2

 

1 – E.I. Chazov National Medical Research Centre of Cardiology.

2 – Sechenov University. Moscow, Russia.

P

urpose. To study the diagnostic significance of computed tomography coronary angiography (CTA) with myocardial perfusion evaluation in examination and treatment patients with chest pain in comparison with data of stress-echocardiography (SE) and invasive fractional flow reserve (FFR).

Materials and methods. A total of 120 patients with chest pain were included in the trial. Standard clinical and instrumental care was followed by CTA on 640-slices computed tomography. If CTA determined moderate coronary artery stenoses (50-85%), stress-CTA with transesophageal atrial pacing (TEP) was carried out. Reversible myocardial ischemia was visually assessed in comparison with data CTA on rest and during TEP (CTA rest/stress). Results of CTA rest/stress were compared with exercise SE. As a «gold standard» the invasive measured FFR was used. FFR≤0.8 indicated the functional significance of coronary artery stenosis.

Results. CTA excluded obstructive coronary artery disease in 29,5% patients. Severe lesion of coronary tree was detected in 7,1% patients. CTA with rest/stress protocol was performed in 60 patients with stenosis 50-85%. Sensitivity, specificity, positive predictive value and negative predictive value when compared with FFR ≤0.8 were 65,5%, 96,8%, 95,0% и 75,0%. A good agreement between CTA rest/stress and SE in identifying reversible myocardial ischemia was received, Cohen’s kappa was 0.7.

Discussion. CTA allows to exclude obstructive coronary artery disease (CAD) with high accuracy and avoid unnecessary invasive procedure. When moderate stenosis (50-85%) of coronary arteries are determined, it is necessary to identify their functional significance. CTA with rest/stress protocol allows to define the reversible ischemia and indications for myocardial revascularization.

Conclusion. Heart CT with evaluation of coronary arteries and reversible myocardial ischemia assessment during one test gives an opportunity to evaluate anatomical and functional significance of CAD in patients with chest pain.

 

Keywords: computed tomography coronary angiography (CTA), moderate stenosis, CTA rest/stress, transesophageal atrial pacing (TEP), fractional flow reserve (FFR).

 

Corresponding author: Balahonova A.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Balahonova A.A., Veselova T.N., Sukhinina T.S., Arutunyan G.K., Shitov V.N., Merkulova I.N., Ternovoy S.K. Diagnostic significance of computed tomography in comprehensive evaluation of coronary arteries and reversible myocardial ischemia in patients with chest pain. REJR 2024; 14(2):19-30. DOI: 10.21569/2222-7415-2024-14-2-19-30.

Received: 14.05.24 Accepted: 05.06.24