Медицинская литература. Новинки

 

 

 

 

 

 

Новые области применения компьютерной томографии сердца в диагностике ишемии миокарда

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КТ-коронарография показала высокую диагностическую точность в диагностике ишемической болезни сердца (ИБС) и стенозов венечных артерий. Тем не менее остаются вопросы функциональной оценки ишемии миокарда, так как степень стеноза артерий и клинические исходы не всегда коррелируют, а оценка гемодинамической значимости стенозов коронарных артерий остается сложной. Отмечено, что исключительное проведение функциональных неинвазивных тестов для оценки возможных стенозов может приводить к ложноотрицательным результатам и, как следствие, ухудшать долгосрочный прогноз вероятности кардиоваскулярных событий. Таким образом, сочетанное применение анатомической и функциональной оценки венечных артерий может улучшить прогноз пациентов с ИБС. В качестве единого (“всё-в-одном”) метода обследования может выступать КТ-коронарография н, дополненная стресс-перфузией и/или измерением фракционного резерва кровотока. Данный обзор представляет собой описание новых методов диагностики ишемии миокарда при проведении КТ коронарных сосудов при стабильной ИБС и перспективы их применения.

Ключевые слова:
компьютерная томография сердца, КТ-коронарная ангиография, ишемия миокарда, перфузия миокарда, стресс-перфузия миокарда, двухэнергетическая компьютерная томография сердца, фракционный резерв кровотока, коронарокальциноз, атеросклероз коронарных артерий, cardiac computed tomography, myocardial ischemia, myocardial perfusion, stress-myocardial perfusion, dual energy computed tomography, fractional f

Литература:
1.Masuda Y., Naito S., Aoyagi Y. et al. Coronary artery calcification detected by CT: clinical significance and angiographic correlates. Angiology. 1990; 41 (12): 10371047. http://doi.org/10.1177/000331979004101203
2.Budoff M.J., Dowe D., Jollis J.G. et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J. Am. Coll. Cardiol. 2008; 52 (21):1724-1732. http://doi.org/10.1016/jJacc.2008.07.031.
3.Ашихмин Я.И., Синицын В.Е., Плиева Н.В., Щекочихин Д.Ю., Копылов Д.Ю. Возможности компьютерной томографии сердца в стратификации риска и определении оптимальной стратегии первичной профилактики сердечнососудистых осложнений атеросклероза. Кардиология. 2019; 59 (6): 70-80. http://doi.org/10.18087/cardio.2019.6.n685.
4.Knuuti J., Wijns W., Saraste A. et al.; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur. Heart J. 2020; 41 (3): 407-477. http://doi.org/10.1093/eurheartj/ehz425
5.Российское кардиологическое общество. Стабильная ишемическая болезнь сердца: Методические рекомендации. 2020, 114 с. https://scardio.ru/content/ Guidelines/2020/Clinic_rekom_IBS.pdf Russian Society of Cardiology.Russian Society of Cardiology. Stable ischemic heart disease. Methodological recommendations. 2020, 114 p. https://scardio.ru/content/Guidelines/2020/Clinic_rekom_IBS.pdf
6.Knuuti J., Ballo H., Juarez-Orozco L.E. et al. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability. Eur. Heart J. 2018; 39 (35): 3322-3330. http://doi.org/10.1093/eurheartj/ehy267
7.Mushtaq S., Conte E., Pontone G. et al. State-of-the-art-myocardial perfusion stress testing: Static CT perfusion. J. Cardiovasc.Comput. Tomogr. 2020; 14 (4): 294-302. http://doi.org/10.1016/jJcct.2019.09.002
8.8. Pelgrim G.J., Dorrius M., Xie X. et al. The dream of a one-stop-shop: Meta-analysis on myocardial perfusion CT. Eur. J. Radiol. 2015; 84 (12): 2411-2420. http://doi.org/10.1016/j.ejrad.2014.12.032.
9.Tonino P.A., Fearon W.F., De Bruyne B. et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J. Am. Coll. Cardiol. 2010; 55 (25): 2816-2821. http://doi.org/10.1016/jJacc.2009.11.096
10.Hoffmann U., Ferencik M., Udelson J.E. et al.; PROMISE Investigators. Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation. 2017; 135 (24): 2320-2332. http://doi.org/10.1161/CIRCULATIONAHA.116.024360
11.Rochitte C.E., George R.T., Chen M.Y. et al.Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study. Eur. Heart J. 2014; 35 (17): 1120-1130. http://doi.org/10.1093/eurheartj/eht488
12.Douglas P.S., Hoffmann U., Patel M.R. et al. Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease. N. Engl. J. Med. 2015; 372: 1291-1300. http://doi.org/10.1056/nejmoa1415516
13.Assen M.V., Vonder M., Pelgrim G.J. et al.Computed tomography for myocardial characterization in ischemic heart disease: a state-of-the-art review. Eur. Radiol. Exp. 2020; 4 (1): 36. http://doi.org/10.1186/s41747-020-00158-1
14.Bucher A.M., De Cecco C.N., Schoepf U.J. et al. Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis. Br. J. Radiol. 2014; 87 (1043): 20140159. http://doi.org/10.1259/bjr.20140159
15.Sorgaard M.H., Kofoed K.F., Linde J.J. et al. Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia. A systematic review and meta-analysis. J. Cardiovasc.Comput. Tomogr. 2016; 10 (6): 450-457. http://doi.org/10.1016/jJcct.2016.09.003
16.Davies J.E., Cook C.M. Is FFRCT Ready to Assume the Crown Jewels of Invasive FFR? J. Am. Coll. Cardiol. Img. 2017; 10 (4): 434-436. http://doi.org/10.1016/jJcmg.2016.06.016
17.Pontone G., Baggiano A., Andreini D. et al. Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease: The PERFECTION Study. JACC Cardiovasc. Imaging. 2019; 12 (8, Pt 1): 1487-1497. http://doi.org/10.1016/jJcmg.2018.08.023
18.Kurata A., Mochizuki T., Koyama Y. et al. Myocardial perfusion imaging using adenosine triphosphate stress multi-slice spiral computed tomography: alternative to stress myocardial perfusion scintigraphy. Circ. J. 2005; 69 (5): 550-557. http://doi.org/10.1253/circj.69.550
19.Maffei E., Martini C., Rossi A. et al. Diagnostic accuracy of second-generation dual-source computed tomography coronary angiography with iterative reconstructions: a real-world experience. Radiol. Med. 2012; 117 (5): 725-738. http://doi.org/10.1007/s11547-011-0754-x
20.Cademartiri F., Seitun S., Clemente A. et al. Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography. Cardiovasc. Diagn. Ther. 2017; 7 (2): 129-150. http://doi.org/10.21037/cdt.2017.03.22
21.Lu M., Wang S., Sirajuddin A. et al. Dynamic stress computed tomography myocardial perfusion for detecting myocardial ischemia: A systematic review and meta-analysis.Int. J. Cardiol. 2018; 258: 325-331. http://doi.org/10.1016/j.ijcard.2018.01.095.
22.Hounsfield G.N.Computerized transverse axial scanning (tomography). 1. Description of system. Br. J. Radiol. 1973; 46 (552):1016-1022. http://doi.org/10.1259/0007-1285-46-552-1016
23.Danad I., Fayad Z.A., Willemink M.J., Min J.K. New Applications of Cardiac Computed Tomography: Dual- Energy, Spectral, and Molecular CT Imaging. JACC Cardiovasc. Imaging. 2015; 8 (6): 710-723. http://doi.org/10.1016/jJcmg.2015.03.005
24.Jin K.N., De Cecco C.N., Caruso D. et al. Myocardial perfusion imaging with dual energy CT. Eur. J. Radiol. 2016; 85 (10): 1914-1921. http://doi.org/10.1016/j.ejrad.2016.06.023
25.Wang R., Yu W., Wang Y. et al. Incremental value of dual-energy CT to coronary CT angiography for the detection of significant coronary stenosis: comparison with quantitative coronary angiography and single photon emission computed tomography.Int. J. Cardiovasc. Imaging. 2011; 27 (5): 647-656. http://doi.org/10.1007/s10554-011-9881-7
26.Ko S.M., Choi J.W., Hwang H.K. et al. Diagnostic performance of combined noninvasive anatomic and functional assessment with dual-source CT and adenosine- induced stress dual-energy CT for detection of significant coronary stenosis. Am. J. Roentgenol. 2012; 198 (3): 512-520. http://doi.org/10.2214/AJR.11.7029
27.Yamada M., Jinzaki M., Kuribayashi S. et al. Beam-hardening correction for virtual monochromatic imaging of myocardial perfusion via fast-switching dual-kVp 64-slice computed tomography: a pilot study using a human heart specimen. Circ. J. 2012; 76 (7): 17991801. http://doi.org/10.1253/circj.CJ-12-0463
28.Bundhun P.K., Yanamala C.M., Huang F Comparing the adverse clinical outcomes associated with fraction flow reserve-guided versus angiography-guided percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc. Disord. 2016; 16 (1): 249. http://doi.org/10.1186/s12872-016-0427-8
29.Ko B.S., Cameron J.D., Munnur R.K. et al. Noninvasive CT-Derived FFR Based on Structural and Fluid Analysis: A Comparison With Invasive FFR for Detection of Functionally Significant Stenosis. JACC Cardiovasc. Imaging. 2017; 10 (6): 663-673. http://doi.org/10.1016/jJcmg.2016.07.005
30.Taylor C.A., Fonte T.A., Min J.K.Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis. J. Am. Coll. Cardiol. 2013; 61 (22): 22332241. http://doi.org/10.1016/jJacc.2012.11.083
31.Tonino P.A., De Bruyne B., Pijls N.H. et al.; FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N. Engl. J. Med. 2009; 360 (3): 213-224. http://doi.org/10.1016/s0145-4145(09)79763-1
32.Ko B.S., Linde J.J., Ihdayhid A.R. et al. Non-invasive CT-derived fractional flow reserve and static rest and stress CT myocardial perfusion imaging for detection of haemodynamically significant coronary stenosis.Int. J. Cardiovasc. Imaging. 2019; 35 (11): 2103-2112. http://doi.org/10.1007/s10554-019-01658-x
33.Zhuang B., Wang S., Zhao S. et al. GW29-e1123 Computed Tomography Angiography-Derived Fractional Flow Reserve (CT-FFR) for the Detection of Myocardial Ischemia-with Invasive Fractional Flow Reserve as Reference: Systematic Review and Meta-Analysis. J. Am. Coll. Cardiol. 2018; 72 (16_Suppl.) C200-C201. http://doi.org/10.1016/j.jacc.2018.08.874
34.Zhuang B., Wang S., Zhao S., Lu M.Computed tomography angiography-derived fractional flow reserve (CT-FFR) for the detection of myocardial ischemia with invasive fractional flow reserve as reference: systematic review and meta-analysis. Eur. Radiol. 2020; 30 (2): 712-725. http://doi.org/10.1007/s00330-019-06470-8.
35.Abbara S., Blanke P., Maroules C.D. et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). J. Cardiovasc.Comput. Tomogr. 2016; 10 (6): 435-449. http://doi.org/10.1016/jJcct.2009.03.004
36.Sharma R.K., Arbab-Zadeh A., Kishi S. et al. Incremental diagnostic accuracy of computed tomography myocardial perfusion imaging over coronary angiography stratified by pre-test probability of coronary artery disease and severity of coronary artery calcification: The CORE320 study.Int. J. Cardiol. 2015; 201: 570-577. http://doi.org/10.1016/j.ijcard.2015.05.110
37.Koo B.K., Erglis A., Doh J.H. et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J. Am. Coll. Cardiol. 2011 Nov 1;58(19): 1989-1997. http://doi.org/10.1016/jJacc.2011.06.066.
38.Синицын В.Е., Глазкова М.А., Мершина Е.А., Архипова И.М. Возможности снижения лучевой нагрузки при проведении мСкТ коронарографии: использование адаптивной статистической итеративной реконструкции. Ангиология и сосудистая хирургия. 2012; 18 (3): 44-49. Sinitsyn V.E., Glazkova M.A., Mershina E.A., Arhipova I.M. Possibilities of decreasing radiation load during MSRT coronarography: using adaptive statistic iterative reconstruction. Angiology and Vascular Surgery. 2012; 18 (3): 44-49. (In Russian)
39.Маткевич Е.И., Синицын В.Е., Зеликман М.И., Кручинин С.А., Иванов И.В. Основные направления снижения дозы облучения пациентов при компьютерной томографии. REJR. 2018; 8 (3), 60-73. http://doi.org/10.21569/2222-7415-2018-8-3-60-73 Matkevich E.I., Sinitsyn V.E., Zelikman M.I., Kruchinin S.A., Ivanov I.V. Main directions of reducing patient irradiation doses in computed tomography. REJR. 2018; 8 (3), 60-73. http://doi.org/10.21569/2222-7415-2018-8-3-60-73 (In Russian)
40.Kerl J.M., Bauer R.W., Maurer T.B. et al. Dose levels at coronary CT angiography - a comparison of Dual Energy-, Dual Source- and 16-slice CT. Eur. Radiol. 2011; 21 (3): 530-537. http://doi.org/10.1007/s00330-010-1954-9
41.Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS); European Association for Percutaneous Cardiovascular Interventions (EAPCI), Wijns W., Kolh P, Danchin N. et al. Guidelines on myocardial revascularization. Eur. Heart J. 2010; 31 (20): 2501-2555. http://doi.org/10.1093/eurheartj/ehq277

New applications of cardiac computed tomography for evaluation of myocardial ischemia

MSCT is known for its extremely high diagnostic accuracy in coronary artery stenosis detection and quantification. However, there are still questions about physiological assessment of myocardial ischemia, since the degree of arterial stenosis and clinical outcomes do not always correlate. It is also noted that the exclusive use of functional non-invasive tests to assess the grade of stenosis can lead to false-negative results and worsen the long-term prognosis of cardiovascular events. Thus, the combined use of anatomical and functional tests can improve the prognosis in coronary heart disease patient. MSCT coronary angiography, combined with stress perfusion and/or CT derived fractional flow reserve, could be used as an all-in-one approach. This review describes new applications of cardiac MSCT.

Keywords:
компьютерная томография сердца, КТ-коронарная ангиография, ишемия миокарда, перфузия миокарда, стресс-перфузия миокарда, двухэнергетическая компьютерная томография сердца, фракционный резерв кровотока, коронарокальциноз, атеросклероз коронарных артерий, cardiac computed tomography, myocardial ischemia, myocardial perfusion, stress-myocardial perfusion, dual energy computed tomography, fractional f