Visually estimated coronary artery calcium score improves SPECT-MPI risk stratification
Aims: Computed tomographic attenuation correction (CTAC) scans for single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) may reveal coronary artery calcification. The independent prognostic value of a visually estimated coronary artery calcium score (VECACS) from these...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-08-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906721001159 |
| _version_ | 1818597880810700800 |
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| author | Cvetan Trpkov Alexei Savtchenko Zhiying Liang Patrick Feng Danielle A. Southern Stephen B. Wilton Matthew T. James Erin Feil Ilias Mylonas Robert J.H. Miller |
| author_facet | Cvetan Trpkov Alexei Savtchenko Zhiying Liang Patrick Feng Danielle A. Southern Stephen B. Wilton Matthew T. James Erin Feil Ilias Mylonas Robert J.H. Miller |
| author_sort | Cvetan Trpkov |
| collection | DOAJ |
| description | Aims: Computed tomographic attenuation correction (CTAC) scans for single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) may reveal coronary artery calcification. The independent prognostic value of a visually estimated coronary artery calcium score (VECACS) from these low-dose, non-gated scans is not established. Methods & Results: VECACS was evaluated in 4,720 patients undergoing SPECT-MPI with CTAC using a 4-point scale. Major adverse cardiac events (MACE) were defined as all-cause mortality, acute coronary syndrome, or revascularization > 90 days after SPECT-MPI. Independent associations with MACE were determined with multivariable Cox proportional hazards analyses adjusted for age, sex, past medical history, perfusion findings, and left ventricular ejection fraction. During a median follow up of 2.9 years (interquartile range 1.8 – 4.2), 494 (10.5%) patients experienced MACE. Compared to absent VECACS, patients with increased VECACS were more likely to experience MACE (all log-rank p < 0.001), and findings were similar when stratified by normal or abnormal perfusion. Multivariable analysis showed an increased MACE risk associated with VECACS categories of equivocal (adjusted hazard ratio [HR] 2.54, 95% CI 1.45–4.45, p = 0.001), present (adjusted HR 2.44, 95% CI 1.74–3.42, p < 0.001) and extensive (adjusted HR 3.47, 95% CI 2.41–5.00, p < 0.001) compared to absent. Addition of VECACS to the multivariable model improved risk classification (continuous net reclassification index 0.207, 95% CI 0.131 – 0.310). Conclusion: VECACS was an independent predictor of MACE in this large SPECT-MPI patient cohort. VECACS from CTAC can be used to improve risk stratification with SPECT-MPI without additional radiation. |
| first_indexed | 2024-12-16T11:54:50Z |
| format | Article |
| id | doaj.art-56330462a0214d8aaa4c441f008a1f06 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-12-16T11:54:50Z |
| publishDate | 2021-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-56330462a0214d8aaa4c441f008a1f062022-12-21T22:32:36ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672021-08-0135100827Visually estimated coronary artery calcium score improves SPECT-MPI risk stratificationCvetan Trpkov0Alexei Savtchenko1Zhiying Liang2Patrick Feng3Danielle A. Southern4Stephen B. Wilton5Matthew T. James6Erin Feil7Ilias Mylonas8Robert J.H. Miller9Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, CanadaDepartment of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, CanadaDepartment of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, CanadaDepartment of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, CanadaDepartment of Medicine, Department of Community Health Sciences, O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, CanadaDepartment of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, CanadaDepartment of Medicine, Department of Community Health Sciences, O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, CanadaDepartment of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, CanadaDepartment of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, CanadaDepartment of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada; Corresponding author at: GAA08, 3230 Hospital Drive NW, Calgary, AB T2N 2T9, Canada.Aims: Computed tomographic attenuation correction (CTAC) scans for single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) may reveal coronary artery calcification. The independent prognostic value of a visually estimated coronary artery calcium score (VECACS) from these low-dose, non-gated scans is not established. Methods & Results: VECACS was evaluated in 4,720 patients undergoing SPECT-MPI with CTAC using a 4-point scale. Major adverse cardiac events (MACE) were defined as all-cause mortality, acute coronary syndrome, or revascularization > 90 days after SPECT-MPI. Independent associations with MACE were determined with multivariable Cox proportional hazards analyses adjusted for age, sex, past medical history, perfusion findings, and left ventricular ejection fraction. During a median follow up of 2.9 years (interquartile range 1.8 – 4.2), 494 (10.5%) patients experienced MACE. Compared to absent VECACS, patients with increased VECACS were more likely to experience MACE (all log-rank p < 0.001), and findings were similar when stratified by normal or abnormal perfusion. Multivariable analysis showed an increased MACE risk associated with VECACS categories of equivocal (adjusted hazard ratio [HR] 2.54, 95% CI 1.45–4.45, p = 0.001), present (adjusted HR 2.44, 95% CI 1.74–3.42, p < 0.001) and extensive (adjusted HR 3.47, 95% CI 2.41–5.00, p < 0.001) compared to absent. Addition of VECACS to the multivariable model improved risk classification (continuous net reclassification index 0.207, 95% CI 0.131 – 0.310). Conclusion: VECACS was an independent predictor of MACE in this large SPECT-MPI patient cohort. VECACS from CTAC can be used to improve risk stratification with SPECT-MPI without additional radiation.http://www.sciencedirect.com/science/article/pii/S2352906721001159AtherosclerosisCoronary artery calciumMyocardial perfusion imagingRisk stratification |
| spellingShingle | Cvetan Trpkov Alexei Savtchenko Zhiying Liang Patrick Feng Danielle A. Southern Stephen B. Wilton Matthew T. James Erin Feil Ilias Mylonas Robert J.H. Miller Visually estimated coronary artery calcium score improves SPECT-MPI risk stratification International Journal of Cardiology: Heart & Vasculature Atherosclerosis Coronary artery calcium Myocardial perfusion imaging Risk stratification |
| title | Visually estimated coronary artery calcium score improves SPECT-MPI risk stratification |
| title_full | Visually estimated coronary artery calcium score improves SPECT-MPI risk stratification |
| title_fullStr | Visually estimated coronary artery calcium score improves SPECT-MPI risk stratification |
| title_full_unstemmed | Visually estimated coronary artery calcium score improves SPECT-MPI risk stratification |
| title_short | Visually estimated coronary artery calcium score improves SPECT-MPI risk stratification |
| title_sort | visually estimated coronary artery calcium score improves spect mpi risk stratification |
| topic | Atherosclerosis Coronary artery calcium Myocardial perfusion imaging Risk stratification |
| url | http://www.sciencedirect.com/science/article/pii/S2352906721001159 |
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