The study of myocardial perfusion by cardiac volumetric computed tomography, combined with adenosine triphosphate test, in a patient with painless myocardial ischemia and atherosclerosis of the coronary arteries

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Abstract


The presented clinical observation demonstrates the diagnostic capabilities of cardiac volumetric computed tomography (CT) with a pharmacological test by a vasodilator adenosine triphosphate (ATP) in the simultaneous assessment of coronary anatomy and changes in left ventricular myocardial perfusion (LV) in a patient with painless myocardial ischemia and coronary atherosclerosis. A 68-year-old patient with coronary heart disease (CHD) and atherosclerotic changes in the coronary arteries underwent cardiac volumetric CT in combination with a ATP pharmacological test. The study was performed on a Aquilion ONE 640 Vision Edition computer tomograph (Toshiba, Japan). Assessment of LV myocardial perfusion was carried out in comparison with other clinical, laboratory and instrumental examination methods. The results of clinical and instrumental examination of a patient with a low pre-test probability of coronary heart disease are presented. From the standpoint of modern recommendations on stable coronary heart disease, false-negative results of single-photon emission computed tomography of the heart and stress-echocardiography are discussed. Clinical observation demonstrates the feasibility of diagnosing LV myocardial ischemia by cardiac volumetric CT combined with ATP pharmacological test, confirmed by an invasive determination of the fractional flow reserve. The given clinical example represents the advantage of cardiac volumetric CT, combined with the ATP pharmacological test, as a method for visualizing LV myocardial perfusion in detecting myocardial ischemia.


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About the authors

G. N. Soboleva

National Medical Research Center for Cardiology

Author for correspondence.
Email: soboleva_galina@inbox.ru
ORCID iD: 0000-0002-6484-5884

Russian Federation, Moscow

д.м.н., вед. науч. сотр. отд. ангиологии, ИКК им. А.Л. Мясникова

S. A. Gaman

National Medical Research Center for Cardiology

Email: soboleva_galina@inbox.ru
ORCID iD: 0000-0002-2165-3911

Russian Federation, Moscow

к.м.н., науч. сотр. отд. томографии

S. K. Ternovoy

National Medical Research Center for Cardiology; Sechenov First Moscow State Medical University (Sechenov University)

Email: soboleva_galina@inbox.ru
ORCID iD: 0000-0002-7841-599X

Russian Federation, Moscow

акад. РАН, д.м.н., проф., рук. отд. томографии; зав. каф. лучевой диагностики и лучевой терапии

Yu. A. Karpov

National Medical Research Center for Cardiology; Sechenov First Moscow State Medical University (Sechenov University)

Email: soboleva_galina@inbox.ru
ORCID iD: 0000-0003-1480-0458

Russian Federation, Moscow

д.м.н., проф., рук. отд. ангиологии

A. A. Minasyan

National Medical Research Center for Cardiology

Email: soboleva_galina@inbox.ru
ORCID iD: 0000-0002-9695-0881

Russian Federation, Moscow

аспирант отд. ангиологии

M. A. Shariya

National Medical Research Center for Cardiology; Sechenov First Moscow State Medical University (Sechenov University)

Email: soboleva_galina@inbox.ru
ORCID iD: 0000-0002-0370-5204

Russian Federation, Moscow

д.м.н., вед. науч. сотр. отд. томографии; проф. каф. лучевой диагностики и лучевой терапии 

V. N. Shitov

National Medical Research Center for Cardiology

Email: soboleva_galina@inbox.ru

Russian Federation, Moscow

к.м.н., мл. науч. сотр. отд. ультразвуковых методов исследования

V. M. Mironov

National Medical Research Center for Cardiology

Email: soboleva_galina@inbox.ru
ORCID iD: 0000-0002-2323-4059

Russian Federation, Moscow

к.м.н., врач отд. рентгенэндоваскулярных методов лечения

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Supplementary files

Supplementary Files Action
1.
Fig. 1. ECG from 03.20.2018: sinus rhythm, heart rate 67 beats/min.

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2.
Fig. 2: a - volumetric CT of the heart at rest. Three-dimensional reconstruction combined with the imposition of polar maps of LV myocardial contrast, projection of the LV anterior wall with visualization of PNA. LV myocardial contrast defects are not determined; b - volumetric CT of the heart during a stress test with ATP. Three-dimensional reconstruction of the heart, combined with the imposition of polar maps of LV myocardial contrast, projection of the LV anterior wall with visualization of PNA. Defusion of perfusion of the middle and apical segments of the anterior, middle segment of the LV lateral wall.

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3.
Fig. 3: a - volumetric CT of the heart at rest. Arterial phase contrast. Cross section along the short axis of the heart at the level of the middle segments of the LV myocardium. LV myocardium is uniformly contrasted throughout; b - volumetric CT of the heart during a stress test with ATP. Arterial phase contrast. Cross section along the short axis of the heart at the level of the middle segments of the LV myocardium. The perfusion defect of the middle and apical segments of the anterior, middle segment of the left ventricular wall (circled by a blue line).

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4.
Fig. 4. An invasive study of the fractional reserve of coronary blood flow (PRK). In the middle segment of PNA PRK 0.76, hemodynamically significant stenosis.

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