Diagnostic accuracy of dynamic computed tomography myocardial perfusion in detecting hemodynamically significant coronary artery stenosis: comparison with invasive instantaneous wave-free ratio

Aim. To evaluate the diagnostic accuracy of computed tomography (CT) myocardial perfusion in comparison with invasive methods (coronary angiography (CAG) and the instantaneous wave-free ratio (iFR)). Material and methods . This single-center prospective observational study consecutively enrolled 96 patients with established or suspected coronary artery disease (CAD). The mean age of the patients was 66,7±10,3 years; 71 (74,0%) were male. A history of percutaneous coronary intervention (PCI) was documented in 50 (52.1%) patients. Indications for prior PCI included stable angina and acute coronary syndrome, including unstable angina and acute myocardial infarction. All patients underwent coronary CT angiography (CCTA) supplemented by pharmacological stress myocardial perfusion (adenosine triphosphate 140 µg/kg/min) to evaluate coronary artery (CA) atherosclerosis according to the Coronary Artery Disease-Reporting and Data System (CAD-RADS, 2016) classification, as well as their hemodynamic significance according to the left ventricular 17-segment model proposed by the American Heart Association (2002). The results were compared with CAG and iFR data, which served as the "gold standard" for diagnosing CA atherosclerosis and their hemodynamic significance. Results. Functionally significant CA lesions (iFR ≤0,89) were identified in 30,2% of patients, while hemodynamically significant stenoses ≥70% (CAD-RADS ≥4) were detected in 31,3% of patients by CCTA. The sensitivity of CT perfusion in diagnosing left ventricular myocardial blood supply defects was 96,6%, while specificity — 71,6%, accuracy — 79,2%, and the negative predictive value reached 98,0%. After excluding cases of microvascular obstruction, the specificity and accuracy of CT perfusion increased to 82,8% and 87,4%, respectively. Conclusion . Dynamic CT myocardial perfusion is a highly sensitive method with a high negative predictive value. It allows for the simultaneous assessment of coronary anatomy and physiology and serves as an effective non-invasive alternative for examining patients with CAd and evaluating the hemodynamic significance of CA stenoses.