Author + information
- Abhishek Sharma, MD∗ ()
- ↵∗Maimonides Medical Center, New York, 1016 50th Street, Apartment 2C, Brooklyn, New York 11219
Dr. Bettencourt and colleagues compare the diagnostic performance of multidetector computed tomography (MDCT) stress-rest perfusion imaging (using significantly lower dose radiation) with cardiac magnetic resonance myocardial perfusion imaging (CMR-Perf) for detection of functionally significant coronary artery disease with fractional flow reserve (FFR) as reference standard (1).
It would be interesting to know the following. First, did the authors make an attempt to compare performance of computed tomography perfusion (CTP) and CMR-Perf among patients with multivessel disease or those with >70% stenosis? Second, did the authors make an attempt to investigate the lesions labeled “false positive” on CTP, which could be incorrectly labeled as “false positive” in setting of nonobstructive coronaries (due to thrombus recannalization or post-percutaneous coronary intervention)? The authors measured FFR in vessels with >40% stenosis; however, abnormal FFR can be found in vessels with lesser degree of stenosis (2). This is more important in setting of microvascular disease, which has worse prognosis. CTP could be particularly helpful in such scenario due to its high resolution and ability to evaluate parameters of endothelial function and microvascular circulation (3).
Though use of 17-segment model to compare CTP and CMR-Perf is itself not perfect, due to overlap of segments between various coronary territories, the current report is a welcome step in the ongoing search for “1-stop” cardiac imaging modality.
However, an important practical limitation of CTP at this time is need for designated software for image analyses and substantial expertise to interpret images and make accurate diagnoses. Further, as patient population in current study was very selective, it would be interesting to see in future studies how MDCT-integrated protocol performs in “real world.”
- American College of Cardiology Foundation
- Bettencourt N.,
- Chiribiri A.,
- Schuster A.,
- et al.
- Ko B.S.,
- Cameron J.D.,
- Meredith I.T.,
- et al.