CT of coronary heart disease: Part 2, dual-phase MDCT evaluates late symptom recurrence in ST-segment elevation myocardial infarction patients after revascularization

Kuan Rau Chiou, Nan Jing Peng, Shih Hung Hsiao, Yi Luan Huang, Chin Chang Cheng, Huay Ben Pan, Ming Ting Wu

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE. The purpose of the study was to investigate dual-phase MDCT for assessing obstructive lesions and the extent and severity of the subtending myocardium at risk in patients presenting with chest pain syndromes 9 or more months after having undergone revascularization for the treatment of ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS. Dual-phase 64-MDCT was performed on 135 patients with recurring chest symptoms 9 months or more after revascularization (mean ± SD, 23 ± 11 months after index invasive angiogram for treatment of STEMI). Obstructive lesions (≥ 50% stenosis) were detected by MDCT angiography and the extent of myocardium at risk was detected by delayed phase 3D myocardium maps. A myocardium at-risk score based on MDCT findings was defined as the extent of myocardium at risk governed by the coronary lesion and weighted by lesion severity. Results were compared with stress-redistribution 201Tl- SPECT and invasive angiography. RESULTS. In restenotic, new, progressive, and previously obstructive lesions that are not currently progressive, analysis of assessable segments (1966/2025, 97.1%) obtained true-positive detection rates of 88.1%, 88.6%, 82.9%, and 100%, respectively; false-negative detection rates were 5.3%, 1.6%, 2.9%, and 8.8%. In 124 patients (91.9%) in whom all segments were assessable, the MDCT-based myocardium at-risk score correlated with the SPECT-based summed difference score (SDS) (r = 0.841, p < 0.001). For detecting SPECT-based SDS ≥ 1 and SDS > 3, areas under the receiver operating characteristic curve for the MDCT-based myocardium at-risk score were 0.874 (95% CI, 0.805-0.942) and 0.938 (95% CI, 0.895-0.981), with optimal cutoff values of 2.68 and 5.01, respectively. CONCLUSION. Dual-phase MDCT is useful in detecting different patterns of obstructive lesions and the extent of myocardium at risk as an alternative for therapeutic planning in patients presenting with late symptoms after treatment for acute myocardial infarction.

Original languageEnglish
Pages (from-to)548-562
Number of pages15
JournalAmerican Journal of Roentgenology
Volume198
Issue number3
DOIs
Publication statusPublished - Mar 1 2012
Externally publishedYes

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Coronary Disease
Myocardium
Recurrence
Angiography
Single-Photon Emission-Computed Tomography
Myocardial Infarction
ST Elevation Myocardial Infarction
Therapeutics
Chest Pain
ROC Curve
Pathologic Constriction
Thorax

Keywords

  • Coronary angiography
  • Coronary stenosis
  • MDCT
  • Myocardial infarction
  • Viability

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

CT of coronary heart disease : Part 2, dual-phase MDCT evaluates late symptom recurrence in ST-segment elevation myocardial infarction patients after revascularization. / Chiou, Kuan Rau; Peng, Nan Jing; Hsiao, Shih Hung; Huang, Yi Luan; Cheng, Chin Chang; Pan, Huay Ben; Wu, Ming Ting.

In: American Journal of Roentgenology, Vol. 198, No. 3, 01.03.2012, p. 548-562.

Research output: Contribution to journalArticle

Chiou, Kuan Rau ; Peng, Nan Jing ; Hsiao, Shih Hung ; Huang, Yi Luan ; Cheng, Chin Chang ; Pan, Huay Ben ; Wu, Ming Ting. / CT of coronary heart disease : Part 2, dual-phase MDCT evaluates late symptom recurrence in ST-segment elevation myocardial infarction patients after revascularization. In: American Journal of Roentgenology. 2012 ; Vol. 198, No. 3. pp. 548-562.
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abstract = "OBJECTIVE. The purpose of the study was to investigate dual-phase MDCT for assessing obstructive lesions and the extent and severity of the subtending myocardium at risk in patients presenting with chest pain syndromes 9 or more months after having undergone revascularization for the treatment of ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS. Dual-phase 64-MDCT was performed on 135 patients with recurring chest symptoms 9 months or more after revascularization (mean ± SD, 23 ± 11 months after index invasive angiogram for treatment of STEMI). Obstructive lesions (≥ 50{\%} stenosis) were detected by MDCT angiography and the extent of myocardium at risk was detected by delayed phase 3D myocardium maps. A myocardium at-risk score based on MDCT findings was defined as the extent of myocardium at risk governed by the coronary lesion and weighted by lesion severity. Results were compared with stress-redistribution 201Tl- SPECT and invasive angiography. RESULTS. In restenotic, new, progressive, and previously obstructive lesions that are not currently progressive, analysis of assessable segments (1966/2025, 97.1{\%}) obtained true-positive detection rates of 88.1{\%}, 88.6{\%}, 82.9{\%}, and 100{\%}, respectively; false-negative detection rates were 5.3{\%}, 1.6{\%}, 2.9{\%}, and 8.8{\%}. In 124 patients (91.9{\%}) in whom all segments were assessable, the MDCT-based myocardium at-risk score correlated with the SPECT-based summed difference score (SDS) (r = 0.841, p < 0.001). For detecting SPECT-based SDS ≥ 1 and SDS > 3, areas under the receiver operating characteristic curve for the MDCT-based myocardium at-risk score were 0.874 (95{\%} CI, 0.805-0.942) and 0.938 (95{\%} CI, 0.895-0.981), with optimal cutoff values of 2.68 and 5.01, respectively. CONCLUSION. Dual-phase MDCT is useful in detecting different patterns of obstructive lesions and the extent of myocardium at risk as an alternative for therapeutic planning in patients presenting with late symptoms after treatment for acute myocardial infarction.",
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T2 - Part 2, dual-phase MDCT evaluates late symptom recurrence in ST-segment elevation myocardial infarction patients after revascularization

AU - Chiou, Kuan Rau

AU - Peng, Nan Jing

AU - Hsiao, Shih Hung

AU - Huang, Yi Luan

AU - Cheng, Chin Chang

AU - Pan, Huay Ben

AU - Wu, Ming Ting

PY - 2012/3/1

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N2 - OBJECTIVE. The purpose of the study was to investigate dual-phase MDCT for assessing obstructive lesions and the extent and severity of the subtending myocardium at risk in patients presenting with chest pain syndromes 9 or more months after having undergone revascularization for the treatment of ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS. Dual-phase 64-MDCT was performed on 135 patients with recurring chest symptoms 9 months or more after revascularization (mean ± SD, 23 ± 11 months after index invasive angiogram for treatment of STEMI). Obstructive lesions (≥ 50% stenosis) were detected by MDCT angiography and the extent of myocardium at risk was detected by delayed phase 3D myocardium maps. A myocardium at-risk score based on MDCT findings was defined as the extent of myocardium at risk governed by the coronary lesion and weighted by lesion severity. Results were compared with stress-redistribution 201Tl- SPECT and invasive angiography. RESULTS. In restenotic, new, progressive, and previously obstructive lesions that are not currently progressive, analysis of assessable segments (1966/2025, 97.1%) obtained true-positive detection rates of 88.1%, 88.6%, 82.9%, and 100%, respectively; false-negative detection rates were 5.3%, 1.6%, 2.9%, and 8.8%. In 124 patients (91.9%) in whom all segments were assessable, the MDCT-based myocardium at-risk score correlated with the SPECT-based summed difference score (SDS) (r = 0.841, p < 0.001). For detecting SPECT-based SDS ≥ 1 and SDS > 3, areas under the receiver operating characteristic curve for the MDCT-based myocardium at-risk score were 0.874 (95% CI, 0.805-0.942) and 0.938 (95% CI, 0.895-0.981), with optimal cutoff values of 2.68 and 5.01, respectively. CONCLUSION. Dual-phase MDCT is useful in detecting different patterns of obstructive lesions and the extent of myocardium at risk as an alternative for therapeutic planning in patients presenting with late symptoms after treatment for acute myocardial infarction.

AB - OBJECTIVE. The purpose of the study was to investigate dual-phase MDCT for assessing obstructive lesions and the extent and severity of the subtending myocardium at risk in patients presenting with chest pain syndromes 9 or more months after having undergone revascularization for the treatment of ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS. Dual-phase 64-MDCT was performed on 135 patients with recurring chest symptoms 9 months or more after revascularization (mean ± SD, 23 ± 11 months after index invasive angiogram for treatment of STEMI). Obstructive lesions (≥ 50% stenosis) were detected by MDCT angiography and the extent of myocardium at risk was detected by delayed phase 3D myocardium maps. A myocardium at-risk score based on MDCT findings was defined as the extent of myocardium at risk governed by the coronary lesion and weighted by lesion severity. Results were compared with stress-redistribution 201Tl- SPECT and invasive angiography. RESULTS. In restenotic, new, progressive, and previously obstructive lesions that are not currently progressive, analysis of assessable segments (1966/2025, 97.1%) obtained true-positive detection rates of 88.1%, 88.6%, 82.9%, and 100%, respectively; false-negative detection rates were 5.3%, 1.6%, 2.9%, and 8.8%. In 124 patients (91.9%) in whom all segments were assessable, the MDCT-based myocardium at-risk score correlated with the SPECT-based summed difference score (SDS) (r = 0.841, p < 0.001). For detecting SPECT-based SDS ≥ 1 and SDS > 3, areas under the receiver operating characteristic curve for the MDCT-based myocardium at-risk score were 0.874 (95% CI, 0.805-0.942) and 0.938 (95% CI, 0.895-0.981), with optimal cutoff values of 2.68 and 5.01, respectively. CONCLUSION. Dual-phase MDCT is useful in detecting different patterns of obstructive lesions and the extent of myocardium at risk as an alternative for therapeutic planning in patients presenting with late symptoms after treatment for acute myocardial infarction.

KW - Coronary angiography

KW - Coronary stenosis

KW - MDCT

KW - Myocardial infarction

KW - Viability

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