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Purpose <p>In patients with reduced remote flow, dynamic stress CT perfusion imaging (CTP) has limited utility for detecting obstructive coronary artery disease (CAD). We compared fractal analysis, a descriptor of macro- and microvascular ischemia patterns, with relative myocardial blood flow (MBF) for detecting obstructive CAD stratified by remote flow.</p> Materials and methods <p>This secondary analysis of the prospective multi-center AMPLIFiED trial included patients who underwent invasive coronary angiography (ICA) with fractional flow reserve (FFR) and dynamic stress CTP. Obstructive CAD was defined invasively (stenosis ≥ 90% or FFR &lt; 0.8). We assessed diagnostic accuracy of fractal analysis and relative MBF in patient groups subdivided into high, intermediate, and low remote flow.</p> Results <p>In 148 patients (30% female; 416 vessels), obstructive CAD was present in 71/148 patients (48%), while signs of microvascular ischemia were found in 26/148 patients (prevalence in high, intermediate, low remote flow: 9%, 37%, 70%). Fractal analysis outperformed relative MBF in detecting obstructive CAD (patient-based sensitivity and specificity: 94% and 92% versus 80% and 64%, <i>p</i> &lt; 0.005). In vessel-based subgroup analysis, both methods performed comparably in high remote flow (area under the receiver-operating curve [AUC]: 0.94 versus 0.88, <i>p</i> = 0.45), while fractal analysis outperformed relative MBF in intermediate and low remote flow (AUC: 0.93 versus 0.77, <i>p</i> = 0.004; 0.92 versus 0.6, <i>p</i> &lt; 0.001).</p> Conclusion <p>Fractal analysis eliminates reliance on remote flow for CTP imaging, which improves diagnostic accuracy for obstructive CAD particularly in patients with reduced remote flow or microvascular ischemia.</p> Trial registration <p>This study reports about data from the prospective, multi-center AMPLIFiED trial (UMIN000016353).</p>

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Fractal analysis of dynamic stress myocardial CT perfusion decouples diagnostic accuracy for obstructive coronary artery disease from remote flow

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月8日

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  • Florian Michallek,
  • Satoshi Nakamura,
  • Masafumi Takafuji,
  • Naoki Nagasawa,
  • Tairo Kurita,
  • Kaoru Dohi,
  • Hideki Ota,
  • Kensuke Nishimiya,
  • Ryo Ogawa,
  • Takehito Shizuka,
  • Hitoshi Nakashima,
  • Naoki Hatori,
  • Yining Wang,
  • Tatsuro Ito,
  • Marc Dewey,
  • Hajime Sakuma,
  • Kakuya Kitagawa

摘要

Purpose

In patients with reduced remote flow, dynamic stress CT perfusion imaging (CTP) has limited utility for detecting obstructive coronary artery disease (CAD). We compared fractal analysis, a descriptor of macro- and microvascular ischemia patterns, with relative myocardial blood flow (MBF) for detecting obstructive CAD stratified by remote flow.

Materials and methods

This secondary analysis of the prospective multi-center AMPLIFiED trial included patients who underwent invasive coronary angiography (ICA) with fractional flow reserve (FFR) and dynamic stress CTP. Obstructive CAD was defined invasively (stenosis ≥ 90% or FFR < 0.8). We assessed diagnostic accuracy of fractal analysis and relative MBF in patient groups subdivided into high, intermediate, and low remote flow.

Results

In 148 patients (30% female; 416 vessels), obstructive CAD was present in 71/148 patients (48%), while signs of microvascular ischemia were found in 26/148 patients (prevalence in high, intermediate, low remote flow: 9%, 37%, 70%). Fractal analysis outperformed relative MBF in detecting obstructive CAD (patient-based sensitivity and specificity: 94% and 92% versus 80% and 64%, p < 0.005). In vessel-based subgroup analysis, both methods performed comparably in high remote flow (area under the receiver-operating curve [AUC]: 0.94 versus 0.88, p = 0.45), while fractal analysis outperformed relative MBF in intermediate and low remote flow (AUC: 0.93 versus 0.77, p = 0.004; 0.92 versus 0.6, p < 0.001).

Conclusion

Fractal analysis eliminates reliance on remote flow for CTP imaging, which improves diagnostic accuracy for obstructive CAD particularly in patients with reduced remote flow or microvascular ischemia.

Trial registration

This study reports about data from the prospective, multi-center AMPLIFiED trial (UMIN000016353).