2021年 · 第101卷第39期

Coronary CTA combined with CT myocardial perfusion imaging (CTP) is an emerging "one-stop" non-invasive imaging method for diagnosing the presence of myocardial ischemia in patients with suspected coronary heart disease. However, there are few studies on the distribution of normal myocardial perfusion in human body. To investigate the global and regional myocardial perfusion of the left ventricle at rest and under adenosine stress in asymptomatic women without a history of coronary artery disease, 34 patients with non-obstructive coronary artery disease (stenosis<50%) or middle-aged women with a history of coronary heart disease, exercise stress tests, and normal left ventricular function, who were subjected to resting versus adenosine-stressed static CTP scans using a 320-slice CT machine and evaluated semi-quantitatively. The study used the left ventricular myocardial 16-segment method to evaluate the myocardial perfusion reserve (MPR) and transmural perfusion ratio (TPR) of the left ventricle as a whole and in each region. The results showed that the distribution of blood perfusion in left ventricular myocardium was not uniform at rest and under load. The overall median MPR increased by 158% (144-176) on stress scan compared with that on resting scan, with the most increase in right coronary artery distribution (171%, P<0.02）。 The TPR values of each myocardial segment ranged from 0.93 to 1.26 and 0.99 to 1.13 at rest and stress scans, respectively, with the lowest value in the left ventricular subventricular interval. There were no significant differences in myocardial perfusion parameters between those with normal subepicardial coronary arteries and those with non-obstructive coronary artery lesions (bothP>0.05）。 Overall myocardial perfusion parameters were not associated with age or female menopausal status (bothP>0.05）。 This descriptive study provides perfusion data for the whole and different zones of the myocardium in a group of healthy middle-aged women.

Coronary computed tomography angiography (CTA) -based blood flow reserve fraction (CT-FFR) is a new technique to assess the physiological significance of coronary artery disease (CAD). CT-FFR is a powerful non-invasive diagnostic tool with significant potential in assessing myocardial ischemia, guiding treatment strategies, and providing prognostic information. Among them, HeartFlow's CT-FFR algorithm (USA, HeartFlow Company) has been validated in 3 multicenter clinical trials. However, HeartFlow's CT-FFR algorithm requires the use of off-site supercomputers for computation, which is time-consuming and expensive, which limits its wide application in clinical practice. Therefore, it makes great sense to develop a CT-FFR technique that can be performed in real time at a field workstation.