Value of dynamic computed tomography myocardial perfusion in CAD: a systematic review and meta-analysis

AIMS: Dynamic stress computed tomography (CT) perfusion is a non-invasive method for quantifying myocardial ischaemia by assessing myocardial blood flow (MBF). In this meta-analysis, we evaluated the diagnostic accuracy of dynamic CT perfusion for the detection of significant coronary artery disease (CAD) across various CT scanners, obese patients, and its prognostic value. METHODS AND RESULTS: We systematically searched PubMed, Embase, Web of Science, and Cochrane library for published studies evaluating the accuracy of CT myocardial perfusion in diagnosing functional significant ischaemia by invasive fractional flow reserve. The diagnostic performance of dynamic CT perfusion in detecting ischaemia was evaluated using a summary receiver operating characteristic (sROC) curve. A total of 23 studies underwent meta-analysis. In myocardial region without ischaemia, MBF was measured at 1.39 mL/min/g [95% confidence interval (CI) 1.25-1.54], while in region with ischaemia, it was 0.92 mL/min/g (95% CI 0.83-1.01) (P < 0.001). On the patient-based analysis, the area under the sROC curve of CT-MBF was 0.92, with a sensitivity of 0.82 and specificity of 0.86. Differences in CT type (dual source vs. single source), and body mass index did not significantly affect the diagnostic performance. The pooled hazard ratio of dynamic CT perfusion for predicting adverse events was 4.98 (95% CI 2.08-11.93, P ≤ 0.001, I2 = 61%, P for heterogeneity = 0.07). CONCLUSION: Dynamic CT perfusion has high diagnostic performance in the quantitative assessment of ischaemia and detection of functional myocardial ischaemia as defined by invasive FFR and may be useful in risk stratification of CAD patients.