Role of computed tomographic dynamic myocardial perfusion in the diagnosis of functional significance of coronary artery stenosis

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Abstract

The presented clinical case demonstrates the use of computed tomographic (CT) angiography for assessment of myocardial perfusion in a comorbid patient with coronary heart disease. According to non-invasive tests data, the patient had borderline stenosis (70%) in the right coronary artery. Estimation the functional significance of stenosis in this case was complicated, because due to comorbidity, in particular the presence of chronic obstructive pulmonary disease (COPD), patient experienced difficulties in performing standard stress tests; in addition, their results were not informative, since shortness of breath could be not only the equivalent of ischemia, but also a manifestation of COPD. Methodic of cardiac CT with pharmacological stress myocardial perfusion assessment made it possible to verify myocardial ischemia, and its results were comparable to the data of invasive coronary angiography. Article discusses the prospects for using CT coronary angiography with myocardial perfusion assessment in clinical practice.

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About the authors

Daria S. Dmitrieva

M.V. Lomonosov Moscow State University

Author for correspondence.
Email: Sergeevna_D9@mail.ru
ORCID iD: 0009-0002-0748-0273

MD, 2nd year resident doctor of the Department of internal medicine of Medical Research and Educational Center

Russian Federation, Moscow

Daria A. Filatova

M.V. Lomonosov Moscow State University

Email: dariafilatova.msu@mail.ru
ORCID iD: 0000-0002-0894-1994

MD, postgraduate student of the Department of radiation diagnostics and therapy, radiologist at the Department of X-ray diagnostics with MRI and CT rooms of Research and Educational Center 

Russian Federation, Moscow

Elena P. Pavlikova

M.V. Lomonosov Moscow State University

Email: elena.pavlikova@inbox.ru
ORCID iD: 0000-0001-7693-5281

MD, Dr. Sci (Medicine), professor of the Department of internal medicine of the Faculty of fundamental medicine, deputy director for clinical work, chief physician of the Medical Research and Educational Center

Russian Federation, Moscow

Tatyana N. Krasnova

M.V. Lomonosov Moscow State University

Email: krasnovamgu@yandex.ru
ORCID iD: 0000-0001-6175-1076

MD, PhD (Medicine), head of the Department of internal diseases of the Faculty of fundamental medicine, leading researcher at the Department of internal diseases of the Medical Research and Educational Center

Russian Federation, Moscow

Elena A. Mershina

M.V. Lomonosov Moscow State University

Email: elena_mershina@mail.ru
ORCID iD: 0000-0002-1266-4926

MD, PhD (Medicine), associate professor of the Department of radiation diagnostics and therapy, head of the Department of X-ray diagnostics with MRI and CT rooms at the Medical Research and Educational Center

Russian Federation, Moscow

Maria V. Lisitskaya

M.V. Lomonosov Moscow State University

Email: Sergeevna_D9@mail.ru
ORCID iD: 0000-0002-8402-7643

MD, PhD (Medicine), radiologist at the Department of X-ray diagnostics with MRI and CT rooms at the Medical Research and Educational Center

Russian Federation, Moscow

Maria A. Trukhanova

M.V. Lomonosov Moscow State University

Email: tryxanova@yandex.ru
ORCID iD: 0000-0002-9957-4906

MD, PhD (Medicine), anesthesiologist-resuscitator, researcher at the Department of internal medicine of the Medical Research and Educational Center

Russian Federation, Moscow

Elena M. Seredenina

M.V. Lomonosov Moscow State University

Email: e.m.seredenina@gmail.com
ORCID iD: 0000-0002-1490-2078

MD, PhD (Medicine), head of the Department of therapy, senior researcher at the Department of age-associated diseases of the Medical Research and Educational Center

Russian Federation, Moscow

Daniil V. Vaypan

M.V. Lomonosov Moscow State University

Email: vdv_zao@mail.ru

MD, general practitioner, researcher at the Department of internal diseases of the Medical Research and Educational Center, assistant at the Department of internal medicine of the Faculty of fundamental medicine

Russian Federation, Moscow

Roman S. Polyakov

M.V. Lomonosov Moscow State University

Email: Roman.polyakov@gmail.com
ORCID iD: 0000-0002-9323-4003

MD, Dr. Sci. (Medicine), head of the Department of X-ray surgical methods of diagnostics and treatment of the Medical Research and Educational Center

Russian Federation, Moscow

Erik L. Vartanyan

M.V. Lomonosov Moscow State University

Email: Sergeevna_D9@mail.ru
ORCID iD: 0000-0001-6757-7101

MD, PhD (Medicine), doctor for X-ray endovascular diagnostics and treatment of the Medical Research and Educational Center

Russian Federation, Moscow

Valentin E. Sinitsyn

M.V. Lomonosov Moscow State University

Email: vsini@mail.ru
ORCID iD: 0000-0002-5649-2193

MD, Dr. Sci. (Medicine), professor, head of the Department of radiation diagnostics of the Medical Research and Educational Center, head of the Department of radiation diagnostics and therapy of the Faculty of fundamental medicine

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig 1. CT coronary data of the observed patient

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3. Fig. 2. Results of myocardial perfusion analysis in the observed patient in different segments at basal (A), middle (B) and apical (C) levels

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4. Fig. 3. Schematic of the 17-segment structure of myocardium

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5. Fig. 4. Electrocardiogram of the observed patient during the procedure: A - before ATP administration, B and C - after ATP administration

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6. Fig. 5. Coronarography data of the observed patient: A - condition before stenting, arrows show areas of arterial lumen narrowing; B - condition after stenting

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