Diagnostic efficiency of myocardial perfusion computed tomography with transesophageal pacing in patients with an initial diagnosis of acute coronary syndrome

Introduction. Computed tomography angiography (CTA) is widely used to detect atherosclerotic changes in coronary arteries (CA). However, the method is limited by the impossibility to perform functional assessment of detected stenoses. Perfusion computed tomography of the myocardium (PCT) can be used for this purpose.

Aim of the study. To assess diagnostic accuracy of PCT of the myocardium with transesophageal electrocardiostimulation (TEES) and stress-echocardiography (stress-echoCG) with veloergometry (VEM) in detection of transient ischemia in patients with initial diagnosis of “acute coronary syndrome” (ACS) with borderline stenoses (50–75%) in CA in relation to measurements of fractional flow reserve (FFR).

Materials and Methods. The study included 30 patients with the initial diagnosis of ACS with borderline (50–75%) stenoses in CA according to CTA or coronary angiography (CAG). Subsequently, they underwent myocardial PCT with 320-row detector with TEES, as well as stress-echoCG with VEM. Invasive FFR measurement was used as a reference method. FFR value < 0.8 indicated hemodynamic significance of stenosis. Myocardial perfusion was assessed visually. Regional myocardial contractility of the left ventricle was assessed by stress-echoCG.

Results. All patients were examined according to the stated protocol. PCT with TEES revealed FFR-significant stenoses with sensitivity, specificity, prognostic value of positive result and prognostic value of negative result 56, 93, 90, 65% respectively, stress-echoCG with VEM 62, 93, 91, 68% respectively.

Conclusion. Myocardial PCT with TEES enables to detect perfusion defects associated with transient ischemia, and the diagnostic accuracy of the method in comparison with FFR is comparable with the already well-proven stress-echoCG. The use of PCT with TEES in combination with CTA can be considered as a promising diagnostic tool in patients without known coronary anatomy and with suspected ACS.

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