Key result
Dynamic CT-MPI combined with CCTA identified the specific etiology in 90.9% (20 of 22) of patients with acute coronary syndrome and non-obstructive coronary angiography.
Why the study?
The diagnostic value of dynamic CT myocardial perfusion imaging combined with coronary CT angiography needed investigation in ACS patients without obstructive coronary angiography.
Does dynamic CT-MPI combined with CCTA identify the underlying etiology in ACS patients with non-obstructive coronary angiography who cannot undergo CMR?
Observational (n=22)
Does dynamic CT-MPI combined with CCTA identify the underlying etiology in ACS patients with non-obstructive coronary angiography who cannot undergo CMR?
Dynamic CT-MPI combined with CCTA is a highly effective alternative to CMR for identifying the underlying etiology in patients with ACS and non-obstructive coronary arteries.
Offers diagnostic alternative for CMR-ineligible ACS patients with non-obstructive coronaries; leaves open validation against outcomes.
Objective: This study sought to investigate the diagnostic value of dynamic CT myocardial perfusion imaging (CT-MPI) combined with coronary CT angiography (CCTA) in acute coronary syndrome (ACS) patients without obstructive coronary angiography. Methods: Consecutive ACS patients with normal or non-obstructive coronary angiography findings who had cardiac magnetic resonance (CMR) contraindications or inability to cooperate with CMR examinations were prospectively enrolled and referred for dynamic CT-MPI + CCTA + late iodine enhancement (LIE). ACS etiology was determined according to combined assessment of coronary vasculature by CCTA, quantified myocardial blood flow (MBF) and presence of LIE. Results: Twenty two patients were included in the final analysis. CCTA revealed two cases of side branch occlusion and one case of intramural hematoma which were overlooked by invasive angiography. High risk plaques were observed in 6 (27.3%) patients whereas myocardial ischemia was presented in 19 (86.4%) patients with varied extent and severity. LIE was positive in 13 (59.1%) patients and microvascular obstruction was presented in three cases with side branch occlusion or spontaneous intramural hematoma. The specific etiology was identified in 20 (90.9%) patients, of which the most common cause was cardiomyopathies (41%), followed by microvascular dysfunction (14%) and plaque disruption (14%). Conclusion: Dynamic CT-MPI + CCTA was able to reveal the potential etiologies in majority of patients with ACS and non-obstructive coronary angiography. It may be a useful alternative to CMR for accurate etiology evaluation.
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Ling et al. (2021) conducted an observational in Acute coronary syndrome with non-obstructive coronary angiography (n=22). Dynamic CT myocardial perfusion imaging (CT-MPI) combined with coronary CT angiography (CCTA) was evaluated on Identification of specific etiology. Dynamic CT-MPI combined with CCTA identified the specific etiology in 90.9% (20 of 22) of patients with acute coronary syndrome and non-obstructive coronary angiography.
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