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Miura S, Okizaki A, Kumamaru H, Manabe O, Naya M, Miyazaki C, Yamashita T. Interaction of impaired myocardial flow reserve and extent of myocardial ischemia assessed using 13N-ammonia positron emission tomography imaging on adverse cardiovascular outcomes. J Nucl Cardiol 2023; 30:2043-2053. [PMID: 37012523 DOI: 10.1007/s12350-023-03255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 02/14/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Myocardial flow reserve (MFR) and the extent of myocardial ischemia identify patients at high risk of major adverse cardiovascular events (MACEs). Associations between positron emission tomography (PET)-assessed extent of ischemia, MFR, and MACEs is unclear. METHOD Overall, 640 consecutive patients with suspected or known coronary artery disease undergoing 13N-ammonia myocardial perfusion PET were followed-up for MACEs. Patients were categorized into three groups based on myocardial ischemia severity: Group I (n = 335), minimal (myocardial ischemia < 5%); Group II (n = 150), mild (5-10%); and Group III (n = 155), moderate-to-severe (> 10%). RESULTS Cardiovascular death and MACEs occurred in 17 (3%) and 93 (15%) patients, respectively. Following statistical adjustment for confounding factors, impaired MFR (global MFR < 2.0) was revealed as an independent predictor of MACEs in Groups I (hazard ratio [HR], 2.89; 95% confidence interval [CI], 1.48-5.64; P = 0.002) and II (HR, 3.40; 95% CI 1.37-8.41; P = 0.008) but was not significant in Group III (HR, 1.15; 95% CI 0.59-2.26; P = 0.67), with a significant interaction (P < 0.0001) between the extent of myocardial ischemia and MFR. CONCLUSION Impaired MFR was significantly associated with increased risk of MACEs in patients with ≤ 10% myocardial ischemia but not with those having > 10% ischemia, allowing a clinically effective risk stratification.
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Affiliation(s)
- Shiro Miura
- Department of Cardiology, Hokkaido Ohno Memorial Hospital, 2-1-16-1 Miyanosawa, Nishi-Ku, Sapporo, 063-0052, Japan.
| | - Atsutaka Okizaki
- Department of Radiology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Manabe
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Saitama-Shi, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido, University Graduate School of Medicine, Sapporo, Japan
| | - Chihoko Miyazaki
- Department of Diagnostic Radiology, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Takehiro Yamashita
- Department of Cardiology, Hokkaido Ohno Memorial Hospital, 2-1-16-1 Miyanosawa, Nishi-Ku, Sapporo, 063-0052, Japan
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Megna R, Petretta M, Nappi C, Assante R, Zampella E, Gaudieri V, Mannarino T, D’Antonio A, Green R, Cantoni V, Panico M, Acampa W, Cuocolo A. Age-Specific Cardiovascular Risk Factors for Major Adverse Cardiac Events in Patients Undergoing Myocardial Perfusion Imaging. J Cardiovasc Dev Dis 2023; 10:395. [PMID: 37754824 PMCID: PMC10531606 DOI: 10.3390/jcdd10090395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/07/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The prevalence of traditional cardiovascular risk factors shows different age-specific patterns. It is not known whether the prognostic impact of risk factors is similarly age-specific. We evaluated the profiles of cardiovascular risk factors and their prognostic impact on coronary artery disease (CAD) in relation to age. METHODS We included 3667 patients with suspected or known CAD undergoing stress myocardial perfusion imaging (MPI). We evaluated the risk for major adverse cardiac events (MACE) within three years from the index MPI in patients belonging to three groups according to age tertile distribution: <59, 59-68, and >68 years. Gender, body mass index, diabetes, hypertension, dyslipidemia, family history of CAD, smoking, angina, dyspnea, previous CAD, and MPI outcome were assessed as risk factors by a multivariable Cox's regression. RESULTS The three-year risk of MACE increased progressively with age and was 9%, 13%, and 18% for each group, respectively (p < 0.0001). Dyspnea and abnormal MPI outcome were significant risk factors for all age groups. Diabetes and smoking were significant from the age of 59 onwards, while hypertension resulted significant for patients older than 68 years. CONCLUSIONS The number of risk factors was significantly associated with the occurrence of MACE increase with age. It is noteworthy that a personal history of CAD was not useful for risk stratification, while MPI results were.
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Affiliation(s)
- Rosario Megna
- Institute of Biostructure and Bioimaging, National Council of Research, via T. De Amicis 95, 80145 Naples, Italy;
| | - Mario Petretta
- IRCCS Synlab SDN, via Gianturco 113, 80143 Naples, Italy;
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Adriana D’Antonio
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Mariarosaria Panico
- Institute of Biostructure and Bioimaging, National Council of Research, via T. De Amicis 95, 80145 Naples, Italy;
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
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Petretta M, Megna R, Assante R, Zampella E, Nappi C, Gaudieri V, Mannarino T, Green R, Cantoni V, D’Antonio A, Panico M, Acampa W, Cuocolo A. External validation and update of the J-ACCESS model in an Italian cohort of patients undergoing stress myocardial perfusion imaging. J Nucl Cardiol 2023; 30:1443-1453. [PMID: 36598749 PMCID: PMC10371932 DOI: 10.1007/s12350-022-03173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cardiovascular risk models are based on traditional risk factors and investigations such as imaging tests. External validation is important to determine reproducibility and generalizability of a prediction model. We performed an external validation of t the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS) model, developed from a cohort of patients undergoing stress myocardial perfusion imaging. METHODS We included 3623 patients with suspected or known coronary artery disease undergoing stress single-photon emission computer tomography (SPECT) myocardial perfusion imaging at our academic center between January 2001 and December 2019. RESULTS In our study population, the J-ACCESS model underestimated the risk of major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and severe heart failure requiring hospitalization) within three-year follow-up. The recalibrations and updated of the model slightly improved the initial performance: C-statistics increased from 0.664 to 0.666 and Brier score decreased from 0.075 to 0.073. Hosmer-Lemeshow test indicated a logistic regression fit only for the calibration slope (P = .45) and updated model (P = .22). In the update model, the intercept, diabetes, and severity of myocardial perfusion defects categorized coefficients were comparable with J-ACCESS. CONCLUSION The external validation of the J-ACCESS model as well as recalibration models have a limited value for predicting of three-year major adverse cardiac events in our patients. The performance in predicting risk of the updated model resulted superimposable to the calibration slope model.
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Affiliation(s)
- Mario Petretta
- IRCCS Synlab SDN, Via Gianturco 113, 80142 Naples, Italy
| | - Rosario Megna
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Adriana D’Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Mariarosaria Panico
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
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Hijazi W, Leslie W, Filipchuk N, Choo R, Wilton S, James M, Slomka PJ, Miller RJH. External validation of the CRAX2MACE model. J Nucl Cardiol 2023; 30:702-707. [PMID: 35419699 PMCID: PMC9556645 DOI: 10.1007/s12350-022-02964-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Single-photon emission computed tomography (SPECT) myocardial perfusion is frequently used to predict risk of major adverse cardiovascular events (MACE). We performed an external validation of the CRAX2MACE score, developed to estimate 2-year risk of MACE in patients with suspected coronary artery disease (CAD). METHODS Patients who underwent clinically indicated SPECT with available follow-up for MACE were included (N = 2,985). The prediction performance for MACE (revascularization, myocardial infarction, or death) within 2 years for CRAX2MACE was compared with stress and ischemic total perfusion deficit (TPD) using area under the receiver operating characteristic curve (AUC). Calibration was assessed with calibration plots, Brier score, and the Hosmer-Lemeshow test. RESULTS MACE occurred within 2 years in 243 (8.1%) patients. The AUC for CRAX2MACE (0.710, 95% CI 0.677-0.743) was significantly higher compared to stress TPD (AUC 0.669, 95% CI 0.632-0.706, P = .010) and ischemic TPD (AUC 0.664, 95% CI 0.627-0.700, P < .001). The model had acceptable goodness-of-fit (P = .103) and was well-calibrated with Brier score of 0.071. CONCLUSION CRAX2MACE had higher predictive performance for 2-year MACE than quantitative perfusion in an external population. The current model is simple to use and could be implemented to assist physicians when estimating patient risk.
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Affiliation(s)
- Waseem Hijazi
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Willam Leslie
- Department of Nuclear Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Neil Filipchuk
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Ryan Choo
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Stephen Wilton
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Matthew James
- Department of Medicine, Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada.
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Hijazi W, Miller RJH. Developing a framework for evaluating and comparing risk models. J Nucl Cardiol 2023; 30:59-61. [PMID: 36575282 DOI: 10.1007/s12350-022-03036-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Waseem Hijazi
- Libin Cardiovascular Institute and Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Robert J H Miller
- Libin Cardiovascular Institute and Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada.
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Sartoretti T, Gennari AG, Sartoretti E, Skawran S, Maurer A, Buechel RR, Messerli M. Fully automated deep learning powered calcium scoring in patients undergoing myocardial perfusion imaging. J Nucl Cardiol 2023; 30:313-320. [PMID: 35301677 PMCID: PMC9984313 DOI: 10.1007/s12350-022-02940-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND To assess the accuracy of fully automated deep learning (DL) based coronary artery calcium scoring (CACS) from non-contrast computed tomography (CT) as acquired for attenuation correction (AC) of cardiac single-photon-emission computed tomography myocardial perfusion imaging (SPECT-MPI). METHODS AND RESULTS Patients were enrolled in this study as part of a larger prospective study (NCT03637231). In this study, 56 Patients who underwent cardiac SPECT-MPI due to suspected coronary artery disease (CAD) were prospectively enrolled. All patients underwent non-contrast CT for AC of SPECT-MPI twice. CACS was manually assessed (serving as standard of reference) on both CT datasets (n = 112) and by a cloud-based DL tool. The agreement in CAC scores and CAC score risk categories was quantified. For the 112 scans included in the analysis, interscore agreement between the CAC scores of the standard of reference and the DL tool was 0.986. The agreement in risk categories was 0.977 with a reclassification rate of 3.6%. Heart rate, image noise, body mass index (BMI), and scan did not significantly impact (p=0.09 - p=0.76) absolute percentage difference in CAC scores. CONCLUSION A DL tool enables a fully automated and accurate estimation of CAC scores in patients undergoing non-contrast CT for AC of SPECT-MPI.
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Affiliation(s)
- Thomas Sartoretti
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Maastricht University Medical Center, Maastricht University, Maastricht, the Netherlands
| | - Antonio G Gennari
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Elisabeth Sartoretti
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Stephan Skawran
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Alexander Maurer
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
- Maastricht University Medical Center, Maastricht University, Maastricht, the Netherlands.
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