The prospective study included 54 asymptomatic high-risk patients who underwent coronary CT angiography (CTA) and regadenoson-induced stress CT perfusion (rsCTP). Diagnostic accuracy of significant stenosis (≥50%) determination was evaluated for CTA alone and CTA + rsCTP in 27 patients referred to ICA due to the positive rsCTP findings. Combined evaluation of CTA + rsCTP had higher diagnostic accuracy over CTA alone (per-segment: specificity 96 versus 68%, p = 0.002; per-vessel: specificity 95 versus 75%, p = 0.012) and high overruling rate of rsCTP was proved in intermediate stenosis (40-70%). Results demonstrate a significant additional value of rsCTP in the assessment of intermediate coronary artery stenosis found with CTA.

Department of Cardiology University Hospital Pilsen Alej Svobody 80 304 60 Pilsen Czech Republic

Department of Imaging Methods University Hospital Pilsen Alej Svobody 80 304 60 Pilsen Czech Republic

Department of Internal Medicine University Hospital Pilsen Alej Svobody 80 304 60 Pilsen Czech Republic

Department of Surgery University Hospital Pilsen Alej Svobody 80 304 60 Pilsen Czech Republic

Siemens Healthcare CT Physics and Applications Development Siemensstrasse 1 91301 Forchheim Germany

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Sun Z., Aziz Y. F. A., Ng K. H. Coronary CT angiography: how should physicians use it wisely and when do physicians request it appropriately? European Journal of Radiology. 2012;81(4):e684–e687. doi: 10.1016/j.ejrad.2011.06.040. PubMed DOI

Patel A. R., Lodato J. A., Chandra S., et al. Detection of myocardial perfusion abnormalities using ultra-low radiation dose regadenoson stress multidetector computed tomography. Journal of Cardiovascular Computed Tomography. 2011;5(4):247–254. doi: 10.1016/j.jcct.2011.06.004. PubMed DOI

Patel A. R., Bhave N. M., Mor-Avi V. Myocardial perfusion imaging with cardiac computed tomography: state of the art. Journal of Cardiovascular Translational Research. 2013;6(5):695–707. doi: 10.1007/s12265-013-9499-3. PubMed DOI

Hadamitzky M., Täubert S., Deseive S., et al. Prognostic value of coronary computed tomography angiography during 5 years of follow-up in patients with suspected coronary artery disease. European Heart Journal. 2013;34(42):3277–3285. doi: 10.1093/eurheartj/eht293. PubMed DOI

Wang Y., Qin L., Shi X., et al. Adenosine-stress dynamic myocardial perfusion imaging with second-generation dual-source CT: comparison with conventional catheter coronary angiography and SPECT nuclear myocardial perfusion imaging. The American Journal of Roentgenology. 2012;198(3):521–529. doi: 10.2214/ajr.11.7830. PubMed DOI

Gallik D. M., Obermueller S. D., Swarna U. S., Guidry G. W., Mahmarian J. J., Verani M. S. Simultaneous assessment of myocardial perfusion and left ventricular function during transient coronary occlusion. Journal of the American College of Cardiology. 1995;25(7):1529–1538. doi: 10.1016/0735-1097(95)00092-I. PubMed DOI

Raff G. L., Abidov A., Achenbach S., et al. SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. Journal of Cardiovascular Computed Tomography. 2009;3(2):122–136. doi: 10.1016/j.jcct.2009.01.001. PubMed DOI

Kim S. M., Choi J.-H., Chang S.-A., Choe Y. H. Additional value of adenosine-stress dynamic CT myocardial perfusion imaging in the reclassification of severity of coronary artery stenosis at coronary CT angiography. Clinical Radiology. 2013;68(12):e659–e668. doi: 10.1016/j.crad.2013.07.015. PubMed DOI

Rochitte C. E., George R. T., Chen M. Y., et al. Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study. European Heart Journal. 2014;35(17):1120–1130. doi: 10.1093/eurheartj/eht488. PubMed DOI PMC

Greif M., von Ziegler F., Bamberg F., et al. CT stress perfusion imaging for detection of haemodynamically relevant coronary stenosis as defined by FFR. Heart. 2013;99(14):1004–1011. doi: 10.1136/heartjnl-2013-303794. PubMed DOI

Kim S. M., Choi J.-H., Chang S.-A., Choe Y. H. Detection of ischaemic myocardial lesions with coronary CT angiography and adenosine-stress dynamic perfusion imaging using a 128-slice dual-source CT: diagnostic performance in comparison with cardiac MRI. British Journal of Radiology. 2013;86(1032) doi: 10.1259/bjr.20130481. PubMed DOI PMC

Ko B. S., Cameron J. D., Defrance T., Seneviratne S. K. CT stress myocardial perfusion imaging using multidetector CT—a review. Journal of Cardiovascular Computed Tomography. 2011;5(6):345–356. doi: 10.1016/j.jcct.2011.10.005. PubMed DOI

Feuchtner G., Goetti R., Plass A., et al. Adenosine stress high-pitch 128-slice dual-source myocardial computed tomography perfusion for imaging of reversible myocardial ischemia: comparison with magnetic resonance imaging. Circulation: Cardiovascular Imaging. 2011;4(5):540–549. doi: 10.1161/circimaging.110.961250. PubMed DOI

Becker A., Becker C. CT imaging of myocardial perfusion: possibilities and perspectives. Journal of Nuclear Cardiology. 2013;20(2):289–296. doi: 10.1007/s12350-013-9681-7. PubMed DOI

Huber A. M., Leber V., Gramer B. M., et al. Myocardium: dynamic versus single-shot CT perfusion imaging. Radiology. 2013;269(2):378–386. doi: 10.1148/radiol.13121441. PubMed DOI

Schwarz F., Hinkel R., Baloch E., et al. Myocardial CT perfusion imaging in a large animal model: comparison of dynamic versus single-phase acquisitions. JACC: Cardiovascular Imaging. 2013;6(12):1229–1238. doi: 10.1016/j.jcmg.2013.05.018. PubMed DOI

Iskandrian A. E., Bateman T. M., Belardinelli L., et al. Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: results of the ADVANCE phase 3 multicenter international trial. Journal of Nuclear Cardiology. 2007;14(5):645–658. doi: 10.1016/j.nuclcard.2007.06.114. PubMed DOI

Roghi A., Palmieri B., Crivellaro W., Sara R., Puttini M., Faletra F. Preoperative assessment of cardiac risk in noncardiac major vascular surgery. The American Journal of Cardiology. 1999;83(2):169–174. doi: 10.1016/s0002-9149(98)00819-4. PubMed DOI

Romero L., de Virgilio C. Preoperative cardiac risk assessment: an updated approach. Archives of Surgery. 2001;136(12):1370–1376. doi: 10.1001/archsurg.136.12.1370. PubMed DOI

Bauer S. M., Cayne N. S., Veith F. J. New developments in the preoperative evaluation and perioperative management of coronary artery disease in patients undergoing vascular surgery. Journal of Vascular Surgery. 2010;51(1):242–251. doi: 10.1016/j.jvs.2009.08.087. PubMed DOI

Kertai M. D., Klein J., Bax J. J., Poldermans D. Predicting perioperative cardiac risk. Progress in Cardiovascular Diseases. 2005;47(4):240–257. doi: 10.1016/j.pcad.2005.01.002. PubMed DOI

Cury R. C., Kitt T. M., Feaheny K., Akin J., George R. T. Regadenoson-stress myocardial CT perfusion and single-photon emission CT: rationale, design, and acquisition methods of a prospective, multicenter, multivendor comparison. Journal of Cardiovascular Computed Tomography. 2014;8(1):2–12. doi: 10.1016/j.jcct.2013.09.004. PubMed DOI

Bettencourt N., Chiribiri A., Schuster A., et al. Direct comparison of cardiac magnetic resonance and multidetector computed tomography stress-rest perfusion imaging for detection of coronary artery disease. Journal of the American College of Cardiology. 2013;61(10):1099–1107. doi: 10.1016/j.jacc.2012.12.020. PubMed DOI

Mehra V. C., Valdiviezo C., Arbab-Zadeh A., et al. A stepwise approach to the visual interpretation of CT-based myocardial perfusion. Journal of Cardiovascular Computed Tomography. 2011;5(6):357–369. doi: 10.1016/j.jcct.2011.10.010. PubMed DOI

Rossi A., Uitterdijk A., Dijkshoorn M., et al. Quantification of myocardial blood flow by adenosine-stress CT perfusion imaging in pigs during various degrees of stenosis correlates well with coronary artery blood flow and fractional flow reserve. European Heart Journal Cardiovascular Imaging. 2013;14(4):331–338. doi: 10.1093/ehjci/jes150. PubMed DOI

Bamberg F., Hinkel R., Schwarz F., et al. Accuracy of dynamic computed tomography adenosine stress myocardial perfusion imaging in estimating myocardial blood flow at various degrees of coronary artery stenosis using a porcine animal model. Investigative Radiology. 2012;47(1):71–77. doi: 10.1097/rli.0b013e31823fd42b. PubMed DOI

Ko B. S., Cameron J. D., Leung M., et al. Combined CT coronary angiography and stress myocardial perfusion imaging for hemodynamically significant stenoses in patients with suspected coronary artery disease: a comparison with fractional flow reserve. JACC: Cardiovascular Imaging. 2012;5(11):1097–1111. doi: 10.1016/j.jcmg.2012.09.004. PubMed DOI

Pijls N. H. J. Fractional flow reserve to guide coronary revascularization. Circulation Journal. 2013;77(3):561–569. doi: 10.1253/circj.cj-13-0161. PubMed DOI