1
|
Nayfeh M, Sayed A, Alwan M, Alfawara M, Al Rifai M, Al-Mallah MH. Hybrid Imaging: Calcium Score and Myocardial Perfusion Imaging. Semin Nucl Med 2024; 54:638-647. [PMID: 39034159 DOI: 10.1053/j.semnuclmed.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 07/23/2024]
Abstract
Coronary heart disease (CHD) remains the top cause of death due to cardiovascular conditions worldwide, with someone suffering a myocardial infarction every 40 seconds. This highlights the importance of non-invasive imaging technologies like myocardial perfusion imaging (MPI), which are crucial for detecting coronary artery disease (CAD) early, even before symptoms appear. However, the reliance solely on MPI has shifted due to its limitations in definitively ruling out atherosclerosis, leading to the adoption of hybrid imaging techniques. Hybrid imaging combines computed tomography (CT) with MPI techniques such as positron emission tomography (PET) and single photon emission computed tomography (SPECT). This integration, often within a single gantry system, enhances the diagnostic accuracy by allowing for attenuation correction (AC), acquisition of the coronary artery calcium score (CACS), and more precise tracing of radiotracer uptake. The built-in CT in modern MPI systems assists in these functions, which is essential for better diagnosis and risk assessment in patients. The addition of CACS to MPI, a method involving the assessment of calcified plaque in coronary arteries, notably enhances diagnostic and prognostic capabilities. CACS helps in identifying atherosclerosis and predicting potential cardiac events, facilitating personalized risk management and the initiation of tailored interventions like statins and aspirin. Such comprehensive imaging strategies not only improve the accuracy of detecting CAD but also help in stratifying patient risk more effectively. In this paper, we discuss how the incorporation of CAC into MPI protocols enhances the diagnostic sensitivity for detecting obstructive CAD, as evidenced by several studies where the addition of CAC to MPI has led to improved outcomes in diagnosing CAD. Moreover, CAC has been shown to unmask silent coronary atherosclerosis in patients with normal MPI results, highlighting its incremental diagnostic value. We will discuss the evolving role of hybrid imaging in guiding therapeutic decisions, particularly the use of statins for cardiovascular prevention. The integration of CAC assessment with MPI not only aids in the early detection and management of CAD but also optimizes therapeutic strategies, enhancing patient care through a more accurate and personalized approach. Such advancements underscore the need for further research to fully establish the benefits of combining CAC with MPI in the clinical assessment of cardiovascular risk.
Collapse
Affiliation(s)
- Malek Nayfeh
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | | | - Maria Alwan
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Moath Alfawara
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | | | | |
Collapse
|
2
|
Dobrolinska MM, Jukema RA, van Velzen SGM, van Diemen PA, Greuter MJW, Prakken NHJ, van der Werf NR, Raijmakers PG, Slart RHJA, Knaapen P, Isgum I, Danad I. The prognostic value of visual and automatic coronary calcium scoring from low-dose computed tomography-[15O]-water positron emission tomography. Eur Heart J Cardiovasc Imaging 2024; 25:1186-1196. [PMID: 38525588 PMCID: PMC11346363 DOI: 10.1093/ehjci/jeae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
AIMS The study aimed, firstly, to validate automatically and visually scored coronary artery calcium (CAC) on low-dose computed tomography (CT) (LDCT) scans with a dedicated calcium scoring CT (CSCT) scan and, secondly, to assess the added value of CAC scored from LDCT scans acquired during [15O]-water-positron emission tomography (PET) myocardial perfusion imaging (MPI) on prediction of major adverse cardiac events (MACE). METHODS AND RESULTS Five hundred seventy-two consecutive patients with suspected coronary artery disease, who underwent [15O]-water-PET MPI with LDCT and a dedicated CSCT scan were included. In the reference CSCT scans, manual CAC scoring was performed, while LDCT scans were scored visually and automatically using deep learning approach. Subsequently, based on CAC score results from CSCT and LDCT scans, each patient's scan was assigned to one out of five cardiovascular risk groups (0, 1-100, 101-400, 401-1000, >1000), and the agreement in risk group classification between CSCT and LDCT scans was investigated. MACE was defined as a composite of all-cause death, non-fatal myocardial infarction, coronary revascularization, and unstable angina. The agreement in risk group classification between reference CSCT manual scoring and visual/automatic LDCT scoring from LDCT was 0.66 [95% confidence interval (CI): 0.62-0.70] and 0.58 (95% CI: 0.53-0.62), respectively. Based on visual and automatic CAC scoring from LDCT scans, patients with CAC > 100 and CAC > 400, respectively, were at increased risk of MACE, independently of ischaemic information from the [15O]-water-PET scan. CONCLUSION There is a moderate agreement in risk classification between visual and automatic CAC scoring from LDCT and reference CSCT scans. Visual and automatic CAC scoring from LDCT scans improve identification of patients at higher risk of MACE.
Collapse
Affiliation(s)
- M M Dobrolinska
- Department of Radiology, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R A Jukema
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S G M van Velzen
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - P A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M J W Greuter
- Department of Radiology, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, Enschede, The Netherlands
| | - N H J Prakken
- Department of Radiology, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - N R van der Werf
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P G Raijmakers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - R H J A Slart
- Department of Radiology, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - P Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - I Isgum
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - I Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| |
Collapse
|
3
|
Williams MC, Shanbhag AD, Zhou J, Michalowska AM, Lemley M, Miller RJH, Killekar A, Waechter P, Gransar H, Van Kriekinge SD, Builoff V, Feher A, Miller EJ, Bateman T, Dey D, Berman D, Slomka PJ. Automated vessel-specific coronary artery calcification quantification with deep learning in a large multi-centre registry. Eur Heart J Cardiovasc Imaging 2024; 25:976-985. [PMID: 38376471 PMCID: PMC11210989 DOI: 10.1093/ehjci/jeae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
AIMS Vessel-specific coronary artery calcification (CAC) is additive to global CAC for prognostic assessment. We assessed accuracy and prognostic implications of vessel-specific automated deep learning (DL) CAC analysis on electrocardiogram (ECG) gated and attenuation correction (AC) computed tomography (CT) in a large multi-centre registry. METHODS AND RESULTS Vessel-specific CAC was assessed in the left main/left anterior descending (LM/LAD), left circumflex (LCX), and right coronary artery (RCA) using a DL model trained on 3000 gated CT and tested on 2094 gated CT and 5969 non-gated AC CT. Vessel-specific agreement was assessed with linear weighted Cohen's Kappa for CAC zero, 1-100, 101-400, and >400 Agatston units (AU). Risk of major adverse cardiovascular events (MACE) was assessed during 2.4 ± 1.4 years follow-up, with hazard ratios (HR) and 95% confidence intervals (CI). There was strong to excellent agreement between DL and expert ground truth for CAC in LM/LAD, LCX and RCA on gated CT [0.90 (95% CI 0.89 to 0.92); 0.70 (0.68 to 0.73); 0.79 (0.77 to 0.81)] and AC CT [0.78 (0.77 to 0.80); 0.60 (0.58 to 0.62); 0.70 (0.68 to 0.71)]. MACE occurred in 242 (12%) undergoing gated CT and 841(14%) of undergoing AC CT. LM/LAD CAC >400 AU was associated with the highest risk of MACE on gated (HR 12.0, 95% CI 7.96, 18.0, P < 0.001) and AC CT (HR 4.21, 95% CI 3.48, 5.08, P < 0.001). CONCLUSION Vessel-specific CAC assessment with DL can be performed accurately and rapidly on gated CT and AC CT and provides important prognostic information.
Collapse
Affiliation(s)
- Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
| | - Aakash D Shanbhag
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
- Signal and Image Processing Institute, Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA
| | - Jianhang Zhou
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
| | - Anna M Michalowska
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
| | - Mark Lemley
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
| | - Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Aditya Killekar
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
| | - Parker Waechter
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
| | - Valerie Builoff
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
| | - Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Timothy Bateman
- Cardiovascular Imaging Technologies LLC, Kansas City, MO, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
| | - Daniel Berman
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Floor 4, Los Angeles 90048 CA, USA
| |
Collapse
|
4
|
Al Rifai M, Winchester D. When should myocardial perfusion imaging be a first-test choice? J Nucl Cardiol 2024; 33:101824. [PMID: 38360263 DOI: 10.1016/j.nuclcard.2024.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Mahmoud Al Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - David Winchester
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
| |
Collapse
|
5
|
Feher A, Pieszko K, Shanbhag A, Lemley M, Bednarski B, Miller RJH, Huang C, Miras L, Liu YH, Sinusas AJ, Slomka PJ, Miller EJ. CT attenuation correction improves quantitative risk prediction by cardiac SPECT in obese patients. Eur J Nucl Med Mol Imaging 2024; 51:695-706. [PMID: 37924340 DOI: 10.1007/s00259-023-06484-x] [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: 05/19/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE This study aimed to compare the predictive value of CT attenuation-corrected stress total perfusion deficit (AC-sTPD) and non-corrected stress TPD (NC-sTPD) for major adverse cardiac events (MACE) in obese patients undergoing cadmium zinc telluride (CZT) SPECT myocardial perfusion imaging (MPI). METHODS The study included 4,585 patients who underwent CZT SPECT/CT MPI for clinical indications (chest pain: 56%, shortness of breath: 13%, other: 32%) at Yale New Haven Hospital (age: 64 ± 12 years, 45% female, body mass index [BMI]: 30.0 ± 6.3 kg/m2, prior coronary artery disease: 18%). The association between AC-sTPD or NC-sTPD and MACE defined as the composite end point of mortality, nonfatal myocardial infarction or late coronary revascularization (> 90 days after SPECT) was evaluated with survival analysis. RESULTS During a median follow-up of 25 months, 453 patients (10%) experienced MACE. In patients with BMI ≥ 35 kg/m2 (n = 931), those with AC-sTPD ≥ 3% had worse MACE-free survival than those with AC-sTPD < 3% (HR: 2.23, 95% CI: 1.40 - 3.55, p = 0.002) with no difference in MACE-free survival between patients with NC-sTPD ≥ 3% and NC-sTPD < 3% (HR:1.06, 95% CI:0.67 - 1.68, p = 0.78). AC-sTPD had higher AUC than NC-sTPD for the detection of 2-year MACE in patients with BMI ≥ 35 kg/m2 (0.631 versus 0.541, p = 0.01). In the overall cohort AC-sTPD had a higher ROC area under the curve (AUC, 0.641) than NC-sTPD (0.608; P = 0.01) for detection of 2-year MACE. In patients with BMI ≥ 35 kg/m2 AC sTPD provided significant incremental prognostic value beyond NC sTPD (net reclassification index: 0.14 [95% CI: 0.20 - 0.28]). CONCLUSIONS AC sTPD outperformed NC sTPD in predicting MACE in patients undergoing SPECT MPI with BMI ≥ 35 kg/m2. These findings highlight the superior prognostic value of AC-sTPD in this patient population and underscore the importance of CT attenuation correction.
Collapse
Affiliation(s)
- Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA.
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
| | - Konrad Pieszko
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark Lemley
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bryan Bednarski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Cathleen Huang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Leonidas Miras
- Division of Cardiology, Bridgeport Hospital, Yale University School of Medicine, Bridgeport, CT, USA
| | - Yi-Hwa Liu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
6
|
Al-Mallah MH, Al Rifai M. Enhancing precision in test choice: Time for a personalized approach. J Nucl Cardiol 2024; 32:101792. [PMID: 38185407 DOI: 10.1016/j.nuclcard.2023.101792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| |
Collapse
|
7
|
Feher A, Pieszko K, Shanbhag A, Lemley M, Miller RJ, Huang C, Miras L, Liu YH, Gerber J, Sinusas AJ, Miller EJ, Slomka PJ. Comparison of the prognostic value between quantification and visual estimation of coronary calcification from attenuation CT in patients undergoing SPECT myocardial perfusion imaging. Int J Cardiovasc Imaging 2024; 40:185-193. [PMID: 37845406 PMCID: PMC466934 DOI: 10.1007/s10554-023-02980-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
We investigated the prognostic utility of visually estimated coronary artery calcification (VECAC) from low dose computed tomography attenuation correction (CTAC) scans obtained during SPECT/CT myocardial perfusion imaging (MPI), and assessed how it compares to coronary artery calcifications (CAC) quantified by calcium score on CTACs (QCAC). From the REFINE SPECT Registry 4,236 patients without prior coronary stenting with SPECT/CT performed at a single center were included (age: 64 ± 12 years, 47% female). VECAC in each coronary artery (left main, left anterior descending, circumflex, and right) were scored separately as 0 (absent), 1 (mild), 2 (moderate), or 3 (severe), yielding a possible score of 0-12 for each patient (overall VECAC grade zero:0, mild:1-2, moderate: 3-5, severe: >5). CAC scoring of CTACs was performed at the REFINE SPECT core lab with dedicated software. VECAC was correlated with categorized QCAC (zero: 0, mild: 1-99, moderate: 100-399, severe: ≥400). A high degree of correlation was observed between VECAC and QCAC, with 73% of VECACs in the same category as QCAC and 98% within one category. There was substantial agreement between VECAC and QCAC (weighted kappa: 0.78 with 95% confidence interval: 0.76-0.79, p < 0.001). During a median follow-up of 25 months, 372 patients (9%) experienced major adverse cardiovascular events (MACE). In survival analysis, both VECAC and QCAC were associated with MACE. The area under the receiver operating characteristic curve for 2-year-MACE was similar for VECAC when compared to QCAC (0.694 versus 0.691, p = 0.70). In conclusion, visual assessment of CAC on low-dose CTAC scans provides good estimation of QCAC in patients undergoing SPECT/CT MPI. Visually assessed CAC has similar prognostic value for MACE in comparison to QCAC.
Collapse
Affiliation(s)
- Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA.
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
| | - Konrad Pieszko
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark Lemley
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert Jh Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Cathleen Huang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Leonidas Miras
- Division of Cardiology, Bridgeport Hospital, Yale University School of Medicine, Bridgeport, CT, USA
| | - Yi-Hwa Liu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA
| | - Jamie Gerber
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
8
|
Kamerman M, van Dijk JD, Timmer JR, Ottervanger JP, Knollema S, Jager PL, Mouden M. The incremental value of coronary artery calcium score in predicting long-term prognosis and defining the warranty period of normal adenosine stress-only myocardial perfusion imaging using CZT SPECT. J Nucl Cardiol 2023; 30:2692-2701. [PMID: 37592058 DOI: 10.1007/s12350-023-03349-6] [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: 04/13/2023] [Accepted: 07/12/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Normal stress-only (SO) myocardial perfusion imaging (MPI) using SPECT reduces imaging time and radiation dose with a good prognosis. However, the long-term prognostic value of combining coronary artery calcium score (CACS) with SO MPI to determine the warranty period remains unknown. Hence, we assessed the incremental prognostic value of CACS and its impact on the warranty period of normal SO MPI using SPECT. METHODS We retrospectively included 1375 symptomatic patients without a history of coronary artery disease (CAD) and a normal SO MPI using adenosine who underwent simultaneous CAC scoring. Annual major adverse cardiac events (MACE) rates were calculated for CACS categories: 0, 1-399, 400-999, and ≥1000. RESULTS The mean age was 60.0 ± 11.8 years (66.9% female) with a median follow-up of 10.3 [IQR 9.6-10.9] years. The warranty period for annual MACE rate for normal SO SPECT extended the total follow-up time in years. MACE rate categorized by CAC categories demonstrated an increase in MACE rates with increasing CACS; CACS 0 and CACS 1-399 were associated with a 10-year warranty period, CACS 400-999 had a warranty period of 4 years and no warranty period could be given for CACS≥1000 (5.9 % at 1 year). CONCLUSIONS CACS as an adjunct to normal pharmacological SO MPI provides additional prognostic information and aids in determining a warranty period.
Collapse
Affiliation(s)
- Mandy Kamerman
- Department of Cardiology, Isala Clinics, Zwolle, The Netherlands.
- Department of Nuclear Medicine, Isala Clinics, Zwolle, The Netherlands.
| | - Joris D van Dijk
- Department of Nuclear Medicine, Isala Clinics, Zwolle, The Netherlands
| | - Jorik R Timmer
- Department of Cardiology, Isala Clinics, Zwolle, The Netherlands
| | | | - Siert Knollema
- Department of Nuclear Medicine, Isala Clinics, Zwolle, The Netherlands
| | - Pieter L Jager
- Department of Nuclear Medicine, Isala Clinics, Zwolle, The Netherlands
| | - Mohamed Mouden
- Department of Cardiology, Isala Clinics, Zwolle, The Netherlands
| |
Collapse
|
9
|
Grant JK, Orringer CE. Coronary and Extra-coronary Subclinical Atherosclerosis to Guide Lipid-Lowering Therapy. Curr Atheroscler Rep 2023; 25:911-920. [PMID: 37971683 DOI: 10.1007/s11883-023-01161-8] [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] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW To discuss and review the technical considerations, fundamentals, and guideline-based indications for coronary artery calcium scoring, and the use of other non-invasive imaging modalities, such as extra-coronary calcification in cardiovascular risk prediction. RECENT FINDINGS The most robust evidence for the use of CAC scoring is in select individuals, 40-75 years of age, at borderline to intermediate 10-year ASCVD risk. Recent US recommendations support the use of CAC scoring in varying clinical scenarios. First, in adults with very high CAC scores (CAC ≥ 1000), the use of high-intensity statin therapy and, if necessary, guideline-based add-on LDL-C lowering therapies (ezetimibe, PCSK9-inhibitors) to achieve a ≥ 50% reduction in LDL-C and optimally an LDL-C < 70 mg/dL is recommended. In patients with a CAC score ≥ 100 at low risk of bleeding, the benefits of aspirin use may outweigh the risk of bleeding. Other applications of CAC scoring include risk estimation on non-contrast CT scans of the chest, risk prediction in younger patients (< 40 years of age), its value as a gatekeeper for the decision to perform nuclear stress testing, and to aid in risk stratification in patients presenting with low-risk chest pain. There is a correlation between extra-coronary calcification (e.g., breast arterial calcification, aortic calcification, and aortic valve calcification) and incident ASCVD events. However, its role in informing lipid management remains unclear. Identification of coronary calcium in selected patients is the single best non-invasive imaging modality to identify future ASCVD risk and inform lipid-lowering therapy decision-making.
Collapse
Affiliation(s)
- Jelani K Grant
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Carl E Orringer
- NCH Rooney Heart Institute, 399 9th Street North, Suite 300, Naples, FL, 34102, USA.
| |
Collapse
|
10
|
Di Carli MF. Future of Radionuclide Myocardial Perfusion Imaging: Transitioning from SPECT to PET. J Nucl Med 2023; 64:3S-10S. [PMID: 37918841 DOI: 10.2967/jnumed.122.264864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/05/2023] [Indexed: 11/04/2023] Open
Affiliation(s)
- Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
11
|
Rozanski A, Han D, Miller RJH, Gransar H, Slomka P, Hayes SW, Friedman JD, Thomson LEJ, Berman DS. Comparison of coronary artery calcium scores among patients referred for cardiac imaging tests. Prog Cardiovasc Dis 2023; 81:24-32. [PMID: 37858662 DOI: 10.1016/j.pcad.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND While coronary artery calcium (CAC) can now be evaluated by multiple imaging modalities, there is presently scant study regarding how CAC scores may vary among populations of varying clinical risk. METHODS We evaluated the distribution of CAC scores among three patient groups: 18,941 referred for CAC scanning, 5101 referred for diagnostic coronary CT angiography (CCTA), and 3307 referred for diagnostic positron emission tomography (PET) myocardial perfusion imaging (MPI). We assessed the relationship between CAC score and myocardial ischemia, obstructive coronary artery disease (CAD), and all-cause mortality across imaging modalities. RESULTS Within each age group, the frequency of CAC abnormalities were relatively similar across testing modalities, despite an annualized mortality rate which varied from 0.5%/year among CAC patients to 3.8%/year among PET-MPI patients (p < 0.001). Among CCTA and PET-MPI patients, a zero CAC score was common, occurring in ~70% of patients <50 years, ~40% of patients 50-59 years, and ~ 25% of patients 60-69 years. Among CCTA patients, zero CAC was associated with a normal coronary angiogram with high frequency, ranging from 92.2% among patients <50 years to 87.9% among patients ≥70 years. Among PET-MPI patients, zero CAC was associated with a very low frequency of inducible ischemia across all age groups, ranging from 1.5% among patients <50 years to 0.9% among patients ≥70 years. CONCLUSIONS In our study, relatively similar CAC scores were noted among patients varying markedly in mortality risk. Clinically, zero CAC scores predicted both a low likelihood of obstructive CAD and inducible myocardial ischemia in all age groups and were observed with high frequency across diagnostic testing modalities.
Collapse
Affiliation(s)
- Alan Rozanski
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Donghee Han
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Robert J H Miller
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America; Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Heidi Gransar
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Piotr Slomka
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Sean W Hayes
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - John D Friedman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Louise E J Thomson
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| |
Collapse
|
12
|
Berman DS. Making fair comparisons: The potency and necessity of combining myocardial perfusion imaging and CAC scanning. J Nucl Cardiol 2023; 30:1751-1755. [PMID: 37624563 DOI: 10.1007/s12350-023-03362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Daniel S Berman
- Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, USA.
| |
Collapse
|
13
|
Fukami M, Matsutomo N, Hashimoto T, Yamamoto T, Sasaki M. Compressed sensing reconstruction shortens the acquisition time for myocardial perfusion imaging: a simulation study. Radiol Phys Technol 2023; 16:397-405. [PMID: 37382801 DOI: 10.1007/s12194-023-00730-5] [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: 02/13/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/30/2023]
Abstract
Compressed sensing (CS) has been used to improve image quality in single-photon emission tomography (SPECT) imaging. However, the effects of CS on image quality parameters in myocardial perfusion imaging (MPI) have not been investigated in detail. This preliminary study aimed to compare the performance of CS-iterative reconstruction (CS-IR) with filtered back-projection (FBP) and maximum likelihood expectation maximization (ML-EM) on their ability to reduce the acquisition time of MPI. A digital phantom that mimicked the left ventricular myocardium was created. Projection images with 120 and 30 directions (360°), and with 60 and 15 directions (180°) were generated. The SPECT images were reconstructed using FBP, ML-EM, and CS-IR. The coefficient of variation (CV) for the uniformity of myocardial accumulation, septal wall thickness, and contrast ratio (Contrast) of the defect/normal lateral wall were calculated for evaluation. The simulation was performed ten times. The CV of CS-IR was lower than that of FBP and ML-EM in both 360° and 180° acquisitions. The septal wall thickness of CS-IR at the 360° acquisition was inferior to that of ML-EM, with a difference of 2.5 mm. Contrast did not differ between ML-EM and CS-IR for the 360° and 180° acquisitions. The CV for the quarter-acquisition time in CS-IR was lower than that for the full-acquisition time in the other reconstruction methods. CS-IR has the potential to reduce the acquisition time of MPI.
Collapse
Affiliation(s)
- Mitsuha Fukami
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi, Tokyo, 181-8612, Japan.
- Department of Medical Quantum Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka-shi, Japan.
| | - Norikazu Matsutomo
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi, Tokyo, 181-8612, Japan
| | - Takeyuki Hashimoto
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi, Tokyo, 181-8612, Japan
| | - Tomoaki Yamamoto
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi, Tokyo, 181-8612, Japan
| | - Masayuki Sasaki
- Department of Medical Quantum Science, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| |
Collapse
|
14
|
Mikail N, Chequer R, Imperiale A, Meisel A, Bengs S, Portmann A, Gimelli A, Buechel RR, Gebhard C, Rossi A. Tales from the future-nuclear cardio-oncology, from prediction to diagnosis and monitoring. Eur Heart J Cardiovasc Imaging 2023; 24:1129-1145. [PMID: 37467476 PMCID: PMC10501471 DOI: 10.1093/ehjci/jead168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023] Open
Abstract
Cancer and cardiovascular diseases (CVD) often share common risk factors, and patients with CVD who develop cancer are at high risk of experiencing major adverse cardiovascular events. Additionally, cancer treatment can induce short- and long-term adverse cardiovascular events. Given the improvement in oncological patients' prognosis, the burden in this vulnerable population is slowly shifting towards increased cardiovascular mortality. Consequently, the field of cardio-oncology is steadily expanding, prompting the need for new markers to stratify and monitor the cardiovascular risk in oncological patients before, during, and after the completion of treatment. Advanced non-invasive cardiac imaging has raised great interest in the early detection of CVD and cardiotoxicity in oncological patients. Nuclear medicine has long been a pivotal exam to robustly assess and monitor the cardiac function of patients undergoing potentially cardiotoxic chemotherapies. In addition, recent radiotracers have shown great interest in the early detection of cancer-treatment-related cardiotoxicity. In this review, we summarize the current and emerging nuclear cardiology tools that can help identify cardiotoxicity and assess the cardiovascular risk in patients undergoing cancer treatments and discuss the specific role of nuclear cardiology alongside other non-invasive imaging techniques.
Collapse
Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Renata Chequer
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018 Paris, France
| | - Alessio Imperiale
- Nuclear Medicine, Institut de Cancérologie de Strasbourg Europe (ICANS), University Hospitals of Strasbourg, 67093 Strasbourg, France
- Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS/Unistra, 67093 Strasbourg, France
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Kantonsspital Glarus, Burgstrasse 99, 8750 Glarus, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Alessia Gimelli
- Imaging Department, Fondazione CNR/Regione Toscana Gabriele Monasterio, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
- Department of Cardiology, University Hospital Inselspital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| |
Collapse
|
15
|
Shah NR, Hulten EA, Tandon S, Murthy VL, Dorbala S, Thompson RC. Recent clinical trials support continued emphasis on patient-first over modality-first approaches to initial test selection in patients with stable ischemic heart disease. J Nucl Cardiol 2023; 30:1739-1744. [PMID: 35149975 DOI: 10.1007/s12350-022-02908-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nishant R Shah
- Division of Cardiology, Department of Medicine, Brown University Alpert Medical School, 830 Chalkstone Avenue, Providence, RI, 02908, USA.
| | - Edward A Hulten
- Department of Medicine, F. Edward Hebert Medical School Uniformed Services, University of Health Sciences, Bethesda, MD, USA
| | - Suman Tandon
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Venkatesh L Murthy
- Departments of Medicine and Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sharmila Dorbala
- Departments of Medicine and Radiology, Harvard Medical School, Boston, MA, USA
| | - Randall C Thompson
- Department of Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, KS, USA
| |
Collapse
|
16
|
van Velzen SGM, Dobrolinska MM, Knaapen P, van Herten RLM, Jukema R, Danad I, Slart RHJA, Greuter MJW, Išgum I. Automated cardiovascular risk categorization through AI-driven coronary calcium quantification in cardiac PET acquired attenuation correction CT. J Nucl Cardiol 2023; 30:955-969. [PMID: 35851642 PMCID: PMC10261233 DOI: 10.1007/s12350-022-03047-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/30/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND We present an automatic method for coronary artery calcium (CAC) quantification and cardiovascular risk categorization in CT attenuation correction (CTAC) scans acquired at rest and stress during cardiac PET/CT. The method segments CAC according to visual assessment rather than the commonly used CT-number threshold. METHODS The method decomposes an image containing CAC into a synthetic image without CAC and an image showing only CAC. Extensive evaluation was performed in a set of 98 patients, each having rest and stress CTAC scans and a dedicated calcium scoring CT (CSCT). Standard manual calcium scoring in CSCT provided the reference standard. RESULTS The interscan reproducibility of CAC quantification computed as average absolute relative differences between CTAC and CSCT scan pairs was 75% and 85% at rest and stress using the automatic method compared to 121% and 114% using clinical calcium scoring. Agreement between automatic risk assessment in CTAC and clinical risk categorization in CSCT resulted in linearly weighted kappa of 0.65 compared to 0.40 between CTAC and CSCT using clinically used calcium scoring. CONCLUSION The increased interscan reproducibility achieved by our method may allow routine cardiovascular risk assessment in CTAC, potentially relieving the need for dedicated CSCT.
Collapse
Affiliation(s)
- S G M van Velzen
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Meibergdreef 123, 1105 AZ, Amsterdam, the Netherlands.
- Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands.
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands.
| | - M M Dobrolinska
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - P Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - R L M van Herten
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Meibergdreef 123, 1105 AZ, Amsterdam, the Netherlands
- Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
| | - R Jukema
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - I Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - R H J A Slart
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
| | - M J W Greuter
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Department of Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
| | - I Išgum
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Meibergdreef 123, 1105 AZ, Amsterdam, the Netherlands
- Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
17
|
Jayadeva PS, Stowers S, Tang EW, Vitola J, Cerci R, Yao J, Westcott J, Elison B, Better N. The impact of coronary calcium score as an addition to myocardial perfusion imaging in altering clinical management (ICCAMPA trial). J Nucl Cardiol 2023; 30:1004-1018. [PMID: 36097241 DOI: 10.1007/s12350-022-03086-2] [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: 01/21/2022] [Accepted: 07/20/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AIM: Myocardial perfusion imaging (MPI) is a key tool for the identification and risk stratification of patients with coronary artery disease. The use of a coronary calcium score further adds to prognostic data above MPI alone. In this study, our aim was to evaluate the extent to which the use of a coronary artery calcium (CAC) score, when co-reported with MPI, impacts changes in clinical management in patients without a history of coronary artery disease (CAD) undergoing functional imaging. METHODS This is a multicenter international study which incorporated a standardized questionnaire to evaluate changes in clinician management after MPI results were given with and without the additional information of a CAC score. Calcium scoring on a SPECT-CT system was performed via a semiquantitative Shemesh score (0-12) with a 0-3 score from the left main, left anterior descending, left circumflex, and right coronary arteries. CT of the chest was read independently, and non-coronary findings were reported alongside the CAC score. RESULTS A total of 281 patients were enrolled across 3 international centers (Brazil, Australia, New Zealand). Of the 281 patients, 133 (47%) had management altered after the clinician was made aware of the CAC score. The impact of the CAC in changing clinical management was significant, particularly in patients with a negative MPI (P < 0.0001), but also in MPI-positive patients (P = 0.0021). The most common management change was the addition or intensification of statin therapy. CONCLUSION The addition of the CAC component to MPI yielded significant management changes in nearly half of all patients undergoing MPI for suspected CAD. This trend was observed across all centers in the three countries involved and was particularly evident in patient with a negative MPI.
Collapse
Affiliation(s)
- Pavithra S Jayadeva
- Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - Stephen Stowers
- Department of Cardiology, Palmerston North Hospital, Palmerston North, New Zealand
| | - E W Tang
- Department of Cardiology, Palmerston North Hospital, Palmerston North, New Zealand
| | - Joao Vitola
- Department of Nuclear Medicine, Quanta Diagnostico por Imagem, Curitiba, Brazil
| | - Rodrigo Cerci
- Department of Nuclear Medicine, Quanta Diagnostico por Imagem, Curitiba, Brazil
| | - Jessica Yao
- Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - James Westcott
- Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Barry Elison
- Department of Nuclear Medicine, Wollongong Hospital, Wollongong, NSW, Australia
| | - Nathan Better
- Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Departments of Nuclear Medicine and Cardiology, Royal Melbourne Hospital, Parkville, Australia
| |
Collapse
|
18
|
Miller RJH, Pieszko K, Shanbhag A, Feher A, Lemley M, Killekar A, Kavanagh PB, Van Kriekinge SD, Liang JX, Huang C, Miller EJ, Bateman T, Berman DS, Dey D, Slomka PJ. Deep Learning Coronary Artery Calcium Scores from SPECT/CT Attenuation Maps Improve Prediction of Major Adverse Cardiac Events. J Nucl Med 2023; 64:652-658. [PMID: 36207138 PMCID: PMC10071789 DOI: 10.2967/jnumed.122.264423] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Low-dose ungated CT attenuation correction (CTAC) scans are commonly obtained with SPECT/CT myocardial perfusion imaging. Despite the characteristically low image quality of CTAC, deep learning (DL) can potentially quantify coronary artery calcium (CAC) from these scans in an automatic manner. We evaluated CAC quantification derived with a DL model, including correlation with expert annotations and associations with major adverse cardiovascular events (MACE). Methods: We trained a convolutional long short-term memory DL model to automatically quantify CAC on CTAC scans using 6,608 studies (2 centers) and evaluated the model in an external cohort of patients without known coronary artery disease (n = 2,271) obtained in a separate center. We assessed agreement between DL and expert annotated CAC scores. We also assessed associations between MACE (death, revascularization, myocardial infarction, or unstable angina) and CAC categories (0, 1-100, 101-400, or >400) for scores manually derived by experienced readers and scores obtained fully automatically by DL using multivariable Cox models (adjusted for age, sex, past medical history, perfusion, and ejection fraction) and net reclassification index. Results: In the external testing population, DL CAC was 0 in 908 patients (40.0%), 1-100 in 596 (26.2%), 100-400 in 354 (15.6%), and >400 in 413 (18.2%). Agreement in CAC category by DL CAC and expert annotation was excellent (linear weighted κ, 0.80), but DL CAC was obtained automatically in less than 2 s compared with about 2.5 min for expert CAC. DL CAC category was an independent risk factor for MACE with hazard ratios in comparison to a CAC of zero: CAC of 1-100 (2.20; 95% CI, 1.54-3.14; P < 0.001), CAC of 101-400 (4.58; 95% CI, 3.23-6.48; P < 0.001), and CAC of more than 400 (5.92; 95% CI, 4.27-8.22; P < 0.001). Overall, the net reclassification index was 0.494 for DL CAC, which was similar to expert annotated CAC (0.503). Conclusion: DL CAC from SPECT/CT attenuation maps agrees well with expert CAC annotations and provides a similar risk stratification but can be obtained automatically. DL CAC scores improved classification of a significant proportion of patients as compared with SPECT myocardial perfusion alone.
Collapse
Affiliation(s)
- Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Konrad Pieszko
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Interventional Cardiology and Cardiac Surgery, University of Zielona Góra, Zielona Góra, Poland
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | - Mark Lemley
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Aditya Killekar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Paul B Kavanagh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Cathleen Huang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | - Timothy Bateman
- Cardiovascular Imaging Technologies LLC, Kansas City, Missouri
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California;
| |
Collapse
|
19
|
Alam L, Omar AMS, Patel KK. Improved Performance of PET Myocardial Perfusion Imaging Compared to SPECT in the Evaluation of Suspected CAD. Curr Cardiol Rep 2023; 25:281-293. [PMID: 36826689 DOI: 10.1007/s11886-023-01851-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE OF REVIEW Myocardial perfusion imaging (MPI) with single photon emission computed tomography (SPECT) has played a central role in the non-invasive evaluation of patients with obstructive coronary artery disease (CAD) for decades. In this review, we discuss the key differences and advantages of positron emission tomography (PET) MPI over SPECT MPI as it relates to the diagnosis, prognosis, as well as clinical decision-making in patients with suspected CAD. RECENT FINDINGS Stress-induced perfusion abnormalities on SPECT help estimate presence, extent, and location of ischemia and flow-limiting obstructive CAD, help with risk stratification, and serve as a gatekeeper to identify patients who will benefit from downstream revascularization versus medical management. Some of the major limitations of SPECT include soft-tissue attenuation artifacts, underestimation of ischemia due to reliance on relative perfusion assessment, and longer protocols with higher radiation dose when performed with traditional equipment. PET MPI addresses most of these limitations and offers better quality images, higher diagnostic accuracy along with shorter protocols and lower radiation dose to the patient. A special advantage of PET scanning lies in the ability to quantify absolute myocardial blood flow and assess true extent of epicardial involvement along with identifying non-obstructive phenotypes of CAD such as diffuse atherosclerosis and microvascular dysfunction. In addition, stress acquisition at/near peak stress with PET allows us to measure left ventricular ejection fraction reserve and myocardial blood flow reserve, which help with identifying patients at a higher risk of future cardiac events and optimally select candidates for revascularization. The several technical advantages of PET MPI position as a superior method to diagnose obstructive and non-obstructive phenotypes of ischemic heart disease affecting the entirety of the coronary circulation offer incremental value for risk stratification and guide post-test management strategy for patients with suspected CAD.
Collapse
Affiliation(s)
- Loba Alam
- Department of Cardiology, Mount Sinai Morningside, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alaa Mabrouk Salem Omar
- Department of Cardiology, Mount Sinai Morningside, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Krishna K Patel
- Department of Cardiology, Mount Sinai Morningside, New York, NY, USA.
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
20
|
Valensi P, Berkane N, Pinto S, Sellier N, Soussan M, Nguyen MT, Cosson E. Performance of the 2019 ESC/EASD guideline strategy for the screening of silent coronary artery disease in patients with diabetes. Cardiovasc Diabetol 2023; 22:33. [PMID: 36793073 PMCID: PMC9930289 DOI: 10.1186/s12933-023-01760-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The 2019 guidelines for cardiovascular risk stratification by the European Society of Cardiology and European Association for the Study of Diabetes (ESC-EASD) suggested screening for silent coronary disease in very high risk patients with severe target organ damage (TOD) (i.e. peripheral occlusive arterial disease or severe nephropathy) or high coronary artery calcium (CAC) score. This study aimed to test the validity of this strategy. METHODS In this retrospective study, we included 385 asymptomatic patients with diabetes and no history of coronary disease but with TOD or ≥ 3 risk factors in addition to diabetes. CAC score was measured using computed tomography scan and a stress myocardial scintigraphy was performed to detect silent myocardial ischemia (SMI), with subsequent coronary angiography in those with SMI. Various strategies to select patients to be screened for SMI were tested. RESULTS CAC score was ≥ 100 Agatston units (AU) in 175 patients (45.5%). SMI was present in 39 patients (10.1%) and among the 30 patients who underwent angiography, 15 had coronary stenoses and 12 had a revascularization procedure. The most effective strategy consisted in performing myocardial scintigraphy in the 146 patients with severe TOD and, among the 239 other patients without severe TOD, in those with CAC ≥ 100 AU: this strategy provided 82% sensitivity for SMI diagnosis, and identified all the patients with stenoses. CONCLUSION The ESC-EASD guidelines suggesting SMI screening in asymptomatic patients with very high risk assessed by severe TOD or high CAC score appears effective and could identify all the patients with stenoses eligible for revascularization.
Collapse
Affiliation(s)
- Paul Valensi
- Unit of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Avenue du 14 Juillet. 93140, Bondy, France.
| | - Narimane Berkane
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
| | - Sara Pinto
- Unit of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Avenue du 14 Juillet. 93140, Bondy, France
| | - Nicolas Sellier
- Department of Radiology, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Bondy, France
| | - Michael Soussan
- Department of Nuclear Medicine, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Bobigny, France
| | - Minh Tuan Nguyen
- Unit of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Avenue du 14 Juillet. 93140, Bondy, France
| | - Emmanuel Cosson
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France.,Unité de Recherche Epidémiologique Nutritionnelle, Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRAE/CNAM/Université Paris13, Bobigny, France
| |
Collapse
|
21
|
Stassen J, van der Bijl P, Bax JJ. Using a deep learning algorithm to score coronary artery calcium in myocardial perfusion imaging: A real opportunity or just a new hype? J Nucl Cardiol 2023; 30:251-253. [PMID: 35725888 DOI: 10.1007/s12350-022-03009-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium.
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiology, University of Turku and Turku University Hospital, Turku, Finland
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| |
Collapse
|
22
|
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.
Collapse
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.
| |
Collapse
|
23
|
van der Bijl P, Stassen J, Bax JJ. Application of a deep learning algorithm to calcium scoring in myocardial perfusion imaging. J Nucl Cardiol 2023; 30:321-323. [PMID: 35352298 DOI: 10.1007/s12350-022-02941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Pieter van der Bijl
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - Jan Stassen
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
- Heart Center, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| |
Collapse
|
24
|
Obtaining a Coronary Artery Calcium Score with Myocardial Perfusion Imaging. Cardiol Clin 2023; 41:177-184. [PMID: 37003675 DOI: 10.1016/j.ccl.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A coronary artery calcium score adds diagnostic and prognostic information to myocardial perfusion imaging and has been shown to alter management. Whenever feasible, coronary calcium assessment should be performed routinely in patients without known coronary artery disease at the time of myocardial perfusion imaging.
Collapse
|
25
|
Han D, Rozanski A, Miller RJH, Sharir T, Einstein AJ, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, Di Carli M, Liang JX, Dey D, Berman DS, Slomka PJ. Prevalence and predictors of automatically quantified myocardial ischemia within a multicenter international registry. J Nucl Cardiol 2022; 29:3221-3232. [PMID: 35174442 PMCID: PMC9378748 DOI: 10.1007/s12350-021-02829-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/13/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The utility of cardiac stress testing depends on the prevalence of myocardial ischemia within candidate populations. However, a comprehensive assessment of the factors influencing frequency of myocardial ischemia within contemporary populations referred for stress testing has not been performed. METHODS We assessed 19,690 patients undergoing nuclear stress testing from a multicenter registry. The chi-square test was used to assess the relative importance of features for predicting myocardial ischemia. RESULTS In the overall cohort, LVEF, male gender, and rest total perfusion deficit (TPD) were the top three predictors of ischemia, followed by CAD status, age, typical angina, and CAD risk factors. Myocardial ischemia was observed in 13.6 % of patients with LVEF > 55 %, in 26.2 % of patients with LVEF 45 %-54 %, and in 48.3% among patients with LVEF < 45 % (P < 0.001). A similar pattern was noted for rest TPD (P < 0.001). Men had a threefold higher frequency of ischemia versus women (25.8 % vs. 8.4%, P < 0.001). Although the relative ranking of ischemia predictors varied among centers, LVEF and/or rest TPD were among the two most potent predictors of myocardial ischemia within each center. CONCLUSION The prevalence of myocardial ischemia varied markedly according to clinical and imaging characteristics. LVEF and rest TPD are robust predictors of myocardial ischemia.
Collapse
Affiliation(s)
- Donghee Han
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Rozanski
- Department of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, 1111 Amsterdam Avenue, New York, NY, 10025, USA.
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, Israel
- Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Andrew J Einstein
- Division of Cardiology, Departments of Medicine and Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Mathews B Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Sharmila Dorbala
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo Di Carli
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - Joanna X Liang
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
26
|
Al-Mallah MH, Bateman TM, Branch KR, Crean A, Gingold EL, Thompson RC, McKenney SE, Miller EJ, Murthy VL, Nieman K, Villines TC, Yester MV, Einstein AJ, Mahmarian JJ. 2022 ASNC/AAPM/SCCT/SNMMI guideline for the use of CT in hybrid nuclear/CT cardiac imaging. J Nucl Cardiol 2022; 29:3491-3535. [PMID: 36056224 DOI: 10.1007/s12350-022-03089-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 01/29/2023]
Affiliation(s)
- Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
| | - Timothy M Bateman
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kelley R Branch
- Division of Cardiovascular, University of Washington, Seattle, WA, USA
| | - Andrew Crean
- Division of Cardiovascular Medicine, Ottawa Heart Institute, Ottawa, ON, Canada
| | - Eric L Gingold
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Randall C Thompson
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Sarah E McKenney
- Department of Radiology, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Michael V Yester
- Department of Radiology, School of Medicine, University of Alabama Medical Center, Birmingham, AL, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - John J Mahmarian
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| |
Collapse
|
27
|
Cardoso R, Shaw LJ, Blumenthal RS, Nasir K, Ferraro R, Maron DJ, Blaha MJ, Gulati M, Bhatt DL, Blankstein R. Preventive cardiology advances in the 2021 AHA/ACC chest pain guideline. Am J Prev Cardiol 2022; 11:100365. [PMID: 35844247 PMCID: PMC9283497 DOI: 10.1016/j.ajpc.2022.100365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/29/2022] [Indexed: 11/08/2022] Open
Abstract
A core principle of the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Chest Pain Guideline is the importance of preventive therapies among patients with nonobstructive or obstructive coronary artery disease (CAD). Accordingly, this editorial provides unique insights that emphasize the role of preventive cardiology throughout the new guideline. For the first time, CAD was defined to also include nonobstructive plaque. This definition was based on the fact that individuals who have nonobstructive plaque are at an increased risk of atherosclerotic events compared with those who do not. Herein, we highlight guideline recommendations related to the diagnosis and management of nonobstructive CAD. We also highlight recommendations which emphasize the importance of preventive therapies. Adoption of these recommendations have the potential to lead to enhanced preventive therapies and improve patient outcomes.
Collapse
|
28
|
Suzuki Y, Matsumoto N, Sugai S, Makita A, Yumikura T, Yoda S, Amano Y, Okumura Y. Relationship Among Coronary Artery Calcium Score, Myocardial Perfusion SPECT and Risk Stratification of Coronary Artery Disease. ANNALS OF NUCLEAR CARDIOLOGY 2022; 8:113-116. [PMID: 36540187 PMCID: PMC9749747 DOI: 10.17996/anc.22-00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 06/17/2023]
Abstract
Since Agatston et al. first reported quantification of the coronary artery calcification score (CACS) in 1990, discussion of its clinical significance and use in diagnostic management has continued. Recent papers have reported the relationship between CACS and myocardial perfusion single photon emission computed tomography (SPECT: MPS) and its combined diagnostic value. When interpreting CACS results, it should be noted that the frequency of significant ischemia detected by MPS, likelihood of coronary artery disease (CAD), and event rate gradually increased from mild to moderate CACS (1-400). At present, high CACS is considered to be moderately consistent with abnormal MPS, and abnormal CACS in normal MPS may contribute to CAD risk stratification. However, it should be noted that CACS=0 does not completely exclude CAD, which is particularly important when using CACS as a gatekeeper for MPS. Both stand-alone computed tomography (CT) scanner and hybrid SPECT-CT scanner are available for combined risk stratification of CACS and MPS in addition to improvement of image quality with attenuation correction.
Collapse
Affiliation(s)
- Yasuyuki Suzuki
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Shonosuke Sugai
- Department of Cardiology, Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Ayano Makita
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Tetsuro Yumikura
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Shunichi Yoda
- Department of Radiology, Nihon University Hospital, Tokyo, Japan
| | - Yasuo Amano
- Division of Cardiology, Department of Medicine, Nihon University, Tokyo, Japan
| | - Yasuo Okumura
- Department of Radiology, Nihon University Hospital, Tokyo, Japan
| |
Collapse
|
29
|
Bonnefoy PB, Janvier L, Arede C, Drouet C, Harami D, Marque S, Ahond-Vionnet R. Reduced acquisition time for thallium myocardial perfusion imaging with large field cadmium-zinc-telluride SPECT/CT cameras: An equivalence study. J Nucl Cardiol 2022; 29:1933-1941. [PMID: 33890184 DOI: 10.1007/s12350-021-02611-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cadmium-zinc-telluride (CZT) SPECT/CT cameras with large field of view offer a higher sensitivity than conventional Anger cameras. This prospective study aimed to determine the equivalence between a conventional protocol and a reduced acquisition time protocol for 201-Thallium myocardial perfusion imaging (MPI) using a whole-body CZT SPECT camera. METHODS AND RESULTS Stress MPI was obtained for 103 consecutive patients on a DISCOVERY-CZT camera. Images were anonymized and post-processed to simulate a 25% (D75 dataset) and 50% (D50 dataset) decrease in total recorded counts. Concerning the number of segments displaying a tracer uptake < 70% of maximum intensity per patient, equivalence was demonstrated for both count-reduced datasets with a good inter-observer agreement (between 0.90 and 0.88). When comparing the full-vs-D75 datasets and full-vs-D50 datasets, mean difference was 0.06 segment (CI95: [- 0.15;0.27], P < 0.001) and 0.518 segment (CI95: [0.28;0.76], P < 0.001) respectively. Inter-observer agreement was also moderate to good concerning the number of pathological segments (between 0.6 and 0.7) and excellent for functional parameters. CONCLUSION Whole-body CZT SPECT/CT cameras allow to reduce 201-Thallium MPI injected activity or acquisition time by 50% with an equivalence in the number of segments displaying a tracer uptake < 70% of maximum intensity and with a good inter-observer agreement.
Collapse
Affiliation(s)
- P B Bonnefoy
- Service de Médecine Nucléaire, Hôpital Pierre Bérégovoy, Nevers, France.
- Service de Médecine Nucléaire, CHU Saint-Etienne - Hôpital Nord, Saint Etienne, France.
- Service de Médecine Nucléaire, CHU de Saint-Etienne, 42055, Saint-Étienne, France.
| | - L Janvier
- Service de Médecine Nucléaire, Hôpital Pierre Bérégovoy, Nevers, France
| | - C Arede
- Service de Médecine Nucléaire, Hôpital Pierre Bérégovoy, Nevers, France
| | - C Drouet
- Service de Médecine Nucléaire, Hôpital Pierre Bérégovoy, Nevers, France
- Service de Médecine Nucléaire, Centre Georges-François Leclerc, Dijon, France
| | - D Harami
- Service de Médecine Nucléaire, Hôpital Pierre Bérégovoy, Nevers, France
| | - S Marque
- Société CAPIONIS, Bordeaux, France
| | - R Ahond-Vionnet
- Service de Médecine Nucléaire, Hôpital Pierre Bérégovoy, Nevers, France
| |
Collapse
|
30
|
Wong JJJ, Yew MS. Implications of transient ischemic dilatation and impaired left ventricular ejection fraction reserve in patients with normal stress myocardial perfusion imaging and elevated coronary artery calcium. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1651-1658. [PMID: 38819545 DOI: 10.1007/s10554-022-02549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/01/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Guidelines recommend stress only (SO) myocardial perfusion imaging (MPI) without follow-up rest imaging if perfusion and left ventricular ejection fraction (LVEF) are normal. However additional rest imaging may show transient ischaemic dilation (TID) and/or impaired LVEF reserve (iLVEFr) suggestive of 'balanced ischemia'. Concurrent coronary artery calcium (CAC) scoring helps to identify subclinical atherosclerosis. The safety of SO MPI when CAC is elevated is unclear. We aim to assess the incidence and outcomes of TID and iLVEFr amongst stress/rest MPIs with normal SO images and elevated CAC. METHODS Retrospective analysis of normal stress/rest MPIs performed between 1 March 2016 to 31 January 2017 with concurrently measured CAC >300. Cases were stratified by presence of TID and/or iLVEFr. Major adverse cardiac events (MACE, defined as cardiac death, non-fatal myocardial infarction and revascularization) within 24 months were compared. RESULTS There were 230 cases included of which 43 (18.7%) had TID and/or iLVEFr. Presence of TID and/or iLVEFr was associated with higher 24-month MACE (23.3 vs. 8.6%, p = 0.013), driven by more elective revascularizations (18.6 vs. 4.3%, p = 0.001). Cardiac death and non-fatal myocardial infarction rates were similar. TID and/or iLVEFr significantly predicted overall MACE after multivariate analysis (OR 2.933 [1.214 - 7.087], p = 0.017). CONCLUSIONS TID and/or iLVEFr is seen in the minority of normal stress MPI with elevated CAC, and is associated with higher 24-month MACE, driven by higher elective revascularizations. Overall cardiac death and non-fatal myocardial infarction rates were low and not significantly different between both groups.
Collapse
Affiliation(s)
| | - Min Sen Yew
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, 308433, Singapore, Singapore.
| |
Collapse
|
31
|
Radial Artery Calcification in Predicting Coronary Calcification and Atherosclerosis Burden. Cardiol Res Pract 2022; 2022:5108389. [PMID: 35685780 PMCID: PMC9174008 DOI: 10.1155/2022/5108389] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 12/30/2022] Open
Abstract
Background Atherosclerosis is a systemic arterial disease with heterogeneous involvement in all vascular beds; however, studies examining the relationship between coronary and radial artery calcification are lacking. The purpose of this study was to assess the relationship between the two sites and the prognostic value of radial artery calcification (RC) for coronary artery disease. Methods This is a single-center, retrospective cross-sectional study based on Doppler ultrasound of radial artery (RUS) and coronary artery angiography (CAG). We included a total of 202 patients undergoing RUS during distal radial access and CAG at the same procedure, between December 2020 and May 2021, from which 103 were found having RC during RUS (RC group) and 99 without (NRC group). Coronary calcifications were evaluated either by angiography examination (moderate and severe), positive CT (>100 Agatson units), or intracoronary imaging (IVUS, OCT). Results A significant correlation was observed between radial calcification and coronary calcification variables (67.3% vs. 32.7%, p=0.001). The correlation between risk factors such as age, smoking, chronic kidney disease, and diabetes mellitus was higher while sex did not play a role. The need of PCI and/or CABG was higher in the RC group (60% vs. 44%, p=0.02). RC, therefore, predicts the extent and severity of coronary artery disease. Conclusion RC may be frequently associated with calcific coronary plaques. These findings highlight the potential beneficial examination of radial arteries whenever CAD is suspected.
Collapse
|
32
|
Blankstein R, Shaw LJ, Gulati M, Atalay MK, Bax J, Calnon DA, Dyke CK, Ferencik M, Heitner JF, Henry TD, Hung J, Knuuti J, Lindner JR, Phillips LM, Raman SV, Rao SV, Rybicki FJ, Saraste A, Stainback RF, Thompson RC, Williamson E, Nieman K, Tremmel JA, Woodard PK, Di Carli MF, Chandrashekhar YS. Implications of the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Chest Pain Guideline for Cardiovascular Imaging: A Multisociety Viewpoint. JACC Cardiovasc Imaging 2022; 15:912-926. [PMID: 35512960 DOI: 10.1016/j.jcmg.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Leslee J Shaw
- Departments of Medicine (Cardiology) and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Martha Gulati
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Michael K Atalay
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Jeroen Bax
- Heart Center, Turku University Hospital, Turku, Finland; Leiden University Medical Centre, Leiden, the Netherlands
| | - Dennis A Calnon
- Ohio Health Heart & Vascular Physicians, Columbus, Ohio, USA
| | | | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio, USA
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Juhani Knuuti
- Heart Center, Turku University Hospital, Turku, Finland
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Subha V Raman
- Indiana University CV Institute and Krannert CV Research Center, Indianapolis, Indiana, USA
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Frank J Rybicki
- University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Antti Saraste
- Heart Center, Turku University Hospital, Turku, Finland; Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Raymond F Stainback
- Texas Heart Institute and Baylor College of Medicine, Division of Cardiology, Houston, Texas, USA
| | - Randall C Thompson
- St. Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | - Koen Nieman
- Stanford University, Palo Alto, California, USA
| | | | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
33
|
Ananthasubramaniam G, Ananthasubramaniam K. Stress Electrocardiography Testing in Coronary Artery Disease: Is It Time for Its Swan Song or To Redefine Its Role in the Modern Era ? Indian Heart J 2022; 74:81-85. [PMID: 35167825 PMCID: PMC9039687 DOI: 10.1016/j.ihj.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/27/2022] Open
Abstract
Stress electrocardiography (sECG) or treadmill stress testing is a well validated noninvasive diagnostic modality available to clinicians at low cost yet providing valuable functional data for coronary artery disease (CAD) diagnostic and prognostic evaluation. With the advances in cardiac imaging in both functional and anatomic fronts and the existing limitations of sECG testing, this modality appears less favored worldwide as reflected in some recent guideline updates. We review the past present and future of sECG to provide a viewpoint on where it stands in CAD evaluation and if it will remain relevant as a diagnostic modality or be retired going forward. We also provide our perspectives on how sECG can co-exist with other modalities such as calcium scoring and discuss the role of such testing in the Indian population.
Collapse
|
34
|
Thompson RC, Al-Mallah MH, Beanlands RSB, Calnon DA, Dorbala S, Phillips LM, Polk DM, Soman P. ASNC's thoughts on the AHA/ACC chest pain guidelines. J Nucl Cardiol 2022; 29:19-23. [PMID: 34782993 DOI: 10.1007/s12350-021-02856-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Randall C Thompson
- St. Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA.
| | | | - Rob S B Beanlands
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
| | | | | | | | | | - Prem Soman
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
35
|
Liu Y, Chen X, Liu X, Yu H, Zhou L, Gao X, Li Q, Su S, Wang L, Zhai J. Accuracy of non-gated low-dose non-contrast chest CT with tin filtration for coronary artery calcium scoring. Eur J Radiol Open 2022; 9:100396. [PMID: 36561207 PMCID: PMC9764023 DOI: 10.1016/j.ejro.2022.100396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 02/01/2023] Open
Abstract
Objective The study investigated the accuracy of coronary artery calcium scores (CACS) and the potential for reducing radiation dose using non-gated low-dose non-contrast chest computed tomography (CT) scanning with tin filtration for one-stop screening of the lungs and heart. Methods A prospective study was conducted,193 Patients received two scans for determining CACS, including an ECG-gated CT at 120 kV (ECG-gated CT), followed by a non-gated low-dose chest CT using 100 kV with tin filtration (non-gated Sn100 kV-LDCT). The Agatston score (AS), risk stratification, and radiation dose were compared between the scan types. Results There was good consistency in the AS from both an ECG-gated CT and a non-gated low-dose chest CT scan, which had a high correlation (r = 0.970). The Kappa value of risk stratification of the two scan types was 0.549. The area under the ROC curve (AUC) of the CACS was used to develop a new risk stratification standard for non-gated Sn100 kV-LDCT evaluation of CACS. In comparison to the CACS measured by ECG-gated CT, non-gated Sn100 kV-LDCT had an AUC of 0.951 and an optimal critical value of 4.6 in the low-risk category. The AUC of low-medium risk was 0.966, and the optimal critical value was 41.2. The AUC of the medium-high risk category was 0.968, and the optimal critical value was 230. The consistency in CACS measured by ECG-gated CT and non-gated Sn100 kV-LDCT had a Kappa value of 0.831. The Effective dose (ED) of non-gated Sn100 kV-LDCT and ECG-gated CT was 0.056 ± 0.017 mSv and 0.685 ± 0.455 mSv, respectively (p < 0.05). Conclusion The Agatston score of CACS using non-gated low-dose chest CT was accurate, but there was an underestimation in risk stratification. This study developed a new risk stratification standard for non-gated Sn100 kV-LDCT evaluation of CACS, which is in closer agreement with CACS derived from ECG-gated CT scans.
Collapse
|
36
|
Mendoza-Ibañez OI, Martínez-Lucio TS, Alexanderson-Rosas E, Slart RH. SPECT in Ischemic Heart Diseases. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
37
|
OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:1423-1433. [DOI: 10.1093/ehjci/jeac082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
|
38
|
Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Cardiovasc Comput Tomogr 2022; 16:54-122. [PMID: 34955448 DOI: 10.1016/j.jcct.2021.11.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
Collapse
|
39
|
Thompson RC. The often-overlooked elements of #PatientFirst imaging: Focus on optimal quality, including up-to-date protocols and equipment. J Nucl Cardiol 2021; 28:3104-3106. [PMID: 34724157 DOI: 10.1007/s12350-021-02836-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
40
|
Moody WE, Holloway B, Arumugam P, Gill S, Wahid YS, Boivin CM, Thomson LE, Berman DS, Armstrong MJ, Ferguson J, Steeds RP. Prognostic value of coronary risk factors, exercise capacity and single photon emission computed tomography in liver transplantation candidates: A 5-year follow-up study. J Nucl Cardiol 2021; 28:2876-2891. [PMID: 32394403 PMCID: PMC8709822 DOI: 10.1007/s12350-020-02126-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/22/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Although consensus-based guidelines support noninvasive stress testing prior to orthotopic liver transplantation (OLT), the optimal screening strategy for assessment of coronary artery disease in patients with end-stage liver disease (ESLD) is unclear. This study sought to determine the relative predictive value of coronary risk factors, functional capacity, and single photon emission computed tomography (SPECT) on major adverse cardiovascular events and all-cause mortality in liver transplantation candidates. METHODS Prior to listing for transplantation, 404 consecutive ESLD patients were referred to a University hospital for cardiovascular (CV) risk stratification. All subjects met at least one of the following criteria: inability to perform > 4 METs by history (62%), insulin-treated diabetes mellitus (53%), serum creatinine > 1.72 mg/dL (8%), history of MI, PCI or CABG (5%), stable angina (3%), cerebrovascular disease (1%), peripheral vascular disease (1%). Subjects underwent Technetium-99m SPECT with multislice coronary artery calcium scoring (CACS) using exercise treadmill or standard adenosine stress in those unable to achieve 85% maximal heart rate (Siemens Symbia T16). Abnormal perfusion was defined as a summed stress score (SSS) ≥ 4. RESULTS Of the 404 patients, 158 (age 59 ± 9 years; male 68%) subsequently underwent transplantation and were included in the primary analysis. Of those, 50 (32%) died after a mean duration follow-up of 5.4 years (maximal 10.9 years). Most deaths (78%) were attributed to noncardiovascular causes (malignancy, sepsis, renal failure). Of the 32 subjects with abnormal perfusion (20%), nine (6%) had a high-risk perfusion abnormality defined as a total perfusion defect size (PDS) ≥ 15% and/or an ischemic PDS ≥ 10%. Kaplan-Meier survival curves demonstrated abnormal perfusion was associated with increased CV mortality (generalized Wilcoxon, P = 0.014) but not all-cause death. Subjects with both abnormal perfusion and an inability to exercise > 4 METs had the lowest survival from all-cause death (P = 0.038). Abnormal perfusion was a strong independent predictor of CV death (adjusted HR 4.2; 95% CI 1.4 to 12.3; P = 0.019) and MACE (adjusted HR 7.7; 95% CI 1.4 to 42.4; P = 0.018) in a multivariate Cox regression model that included age, sex, diabetes, smoking and the ability to exercise > 4 METs. There was no association between CACS and the extent of perfusion abnormality, nor with outcomes. CONCLUSIONS Most deaths following OLT are noncardiovascular. Nonetheless, abnormal perfusion is prevalent in this high-risk population and a stronger predictor of cardiovascular morbidity and mortality than functional status. A combined assessment of functional status and myocardial perfusion identifies those at highest risk of all-cause death. (Exercise Capacity and Single Photon Emission Computed Tomography in Liver Transplantation Candidates [ExSPECT]; ClinicalTrials.gov Identifier: NCT03864497).
Collapse
Affiliation(s)
- William E Moody
- Department of Nuclear Medicine, Centre for Clinical Cardiovascular Science, Nuffield House, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Edgbaston, B15 2TH, UK.
| | - Benjamin Holloway
- Department of Nuclear Medicine, Centre for Clinical Cardiovascular Science, Nuffield House, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Edgbaston, B15 2TH, UK
| | - Parthiban Arumugam
- Department of Nuclear Medicine, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Sharon Gill
- Department of Nuclear Medicine, Centre for Clinical Cardiovascular Science, Nuffield House, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Edgbaston, B15 2TH, UK
| | - Yasmin S Wahid
- Department of Nuclear Medicine, Centre for Clinical Cardiovascular Science, Nuffield House, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Edgbaston, B15 2TH, UK
| | - Chris M Boivin
- Department of Nuclear Medicine, Centre for Clinical Cardiovascular Science, Nuffield House, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Edgbaston, B15 2TH, UK
| | - Louise E Thomson
- Departments of Imaging and Medicine, S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine, S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Matthew J Armstrong
- Department of Liver Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2TH, UK
- Institute of Immunology and Immunotherapy, National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
| | - James Ferguson
- Department of Liver Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2TH, UK
- Institute of Immunology and Immunotherapy, National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
| | - Richard P Steeds
- Department of Nuclear Medicine, Centre for Clinical Cardiovascular Science, Nuffield House, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Edgbaston, B15 2TH, UK
| |
Collapse
|
41
|
Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78:e187-e285. [PMID: 34756653 DOI: 10.1016/j.jacc.2021.07.053] [Citation(s) in RCA: 319] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
Collapse
|
42
|
2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78:2218-2261. [PMID: 34756652 DOI: 10.1016/j.jacc.2021.07.052] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended.
Collapse
|
43
|
Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144:e368-e454. [PMID: 34709879 DOI: 10.1161/cir.0000000000001029] [Citation(s) in RCA: 152] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
Collapse
|
44
|
Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144:e368-e454. [PMID: 34709928 DOI: 10.1161/cir.0000000000001030] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended.
Collapse
|
45
|
Sharma V, Mughal L, Dimitropoulos G, Sheikh A, Griffin M, Moss A, Notghi A, Pandit M, Connolly DL, Varma C, Kirchhof P. The additive prognostic value of coronary calcium score (CCS) to single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI)-real world data from a single center. J Nucl Cardiol 2021; 28:2086-2096. [PMID: 31797319 DOI: 10.1007/s12350-019-01965-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 01/07/2023]
Abstract
AIMS Single-photon emission computed tomography myocardial perfusion imaging [SPECT-MPI] is a functional test for coronary ischemia. We aimed to assess the additive prognostic value of coronary calcium score (CCS) to SPECT-MPI in stable patients. METHODS This study is a retrospective analysis of 655 patients who underwent SPECT-MPI with CCS (2012 to 2017). Receiver operator characteristic (ROC) identified CCS cutoff value for all-cause mortality: CCS+ if > cutoff value and MPI+ if ≥ 5% total perfusion defect (TPD). Patients were divided into 1 MPI-/CCS-; 2 MPI+/CCS-; 3 MPI-/CCS+; 4 MPI+/CCS+ and compared. Cox proportional hazard analysis identified predictors of mortality. RESULTS CCS cutoff for all-cause mortality was > 216 (C statistic 0.756, P < 0.0001). In MPI+ groups, mean TPD was similar (13.4% and 13.1% respectively) but mortality was higher in the CCS+ (12.5% vs. 4.8%, P = 0.22) as was the severe LV systolic dysfunction (8.0% vs. 0%, P = 0.095). In MPI- groups, mean TPD was similar (0.7% and 0.9% respectively) but all-cause mortality was higher in the CCS+ (10.7% vs. 1.6%, P < 0.0001) as was severe LVSD (2.9 % vs. 0.3% P = 0.016). Age, smoking, renal impairment ,and CCS > 216 were independent predictors of mortality. CONCLUSIONS Patients with raised CCS on SPECT-MPI have increased mortality and poor LV function despite a negative MPI.
Collapse
Affiliation(s)
- Vinoda Sharma
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom.
| | - Lal Mughal
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | | | - Awais Sheikh
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Michael Griffin
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Alexandra Moss
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Alp Notghi
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Manish Pandit
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Derek L Connolly
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Chetan Varma
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Paulus Kirchhof
- Birmingham City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, B18 7QH, United Kingdom
| |
Collapse
|
46
|
Pyslar N, Doukky R. Myocardial perfusion imaging and coronary calcium score: A marriage made in heaven. J Nucl Cardiol 2021; 28:2097-2099. [PMID: 31797318 DOI: 10.1007/s12350-019-01966-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Nataliya Pyslar
- Division of Cardiology, Cook County Health, Chicago, IL, USA
| | - Rami Doukky
- Division of Cardiology, Cook County Health, Chicago, IL, USA.
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
47
|
Cherukuri L, Birudaraju D, Budoff MJ. Coronary artery calcium score: pivotal role as a predictor for detecting coronary artery disease in symptomatic patients. Coron Artery Dis 2021; 32:578-585. [PMID: 33471470 DOI: 10.1097/mca.0000000000000999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Chest pain and dyspnea are common presentations for symptomatic individuals with suspected coronary artery disease (CAD) in the primary care office and cardiology clinics. However, it is imperative to properly diagnose who should undergo further evaluation for cardiac etiologies of chest pain, with either noninvasive or invasive imaging tests. The purpose of this review is to highlight the role of coronary artery calcium (CAC) score as a screening tool for symptomatic patients to detect CAD. The purpose of CAC scoring is to establish the presence and severity of coronary atherosclerosis that can play a vital role in symptomatic patients. The use of CAC testing in symptomatic patients has traditionally been limited due to fundamental concerns, including the occurrence of coronary calcification relatively late in the atherosclerotic process and high prevalence of CAC in the population. Further issue relates to its low specificity for obstructive CAD, as well as demonstration of significant ethnic variability in plaque composition and calcification patterns. CAC testing gained attention as an inexpensive, rapid, reproducible and a well-tolerated alternative to exclude CAD in symptomatic patients and defer further invasive imaging tests. This article will review the available literature in regard to the use of CAC in symptomatic populations.
Collapse
|
48
|
Nappi C, Gaudieri V, Cuocolo A. Computed tomography calls out nuclear imaging in its field: It doesn't matter how you are searching but what you are looking for. J Nucl Cardiol 2021; 28:1715-1717. [PMID: 31646470 DOI: 10.1007/s12350-019-01926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
| |
Collapse
|
49
|
El Mahdiui M, Smit JM, van Rosendael AR, Jukema JW, Bax JJ, Scholte AJHA. Relationship between coronary artery calcification and myocardial ischemia on computed tomography myocardial perfusion in patients with stable chest pain. J Nucl Cardiol 2021; 28:1707-1714. [PMID: 31529386 PMCID: PMC8421270 DOI: 10.1007/s12350-019-01869-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Coronary artery calcium (CAC) score has shown to provide incremental prognostic information when added to the Framingham risk score. Although the relation between CAC and myocardial ischemia has been evaluated, there has been little evaluation of the relationship between CAC score and inducible myocardial ischemia on computed tomography myocardial perfusion (CTP). METHODS AND RESULTS Patients who were referred with stable chest pain from the outpatient clinic and who underwent non-contrast computed tomography scan, coronary computed tomography angiography, and adenosine stress CTP were included in this study. CAC score was subdivided in four groups (1 to 99; 100 to 399, 400 to 999, and ≥ 1000). Inducible myocardial ischemia was considered when reversible perfusion defects were observed in ≥ 1 segment. A total of 131 patients (age 62 ± 9.4 years; 56% male) were included. The median CAC score was 241 (73 to 539). Forty-nine patients (37%) had evidence of inducible myocardial ischemia. The presence of inducible myocardial ischemia increased with increasing CAC score from 22% in the CAC score 1 to 99 subgroup to 35, 47, and 65% in the 100 to 399, 400 to 999, and ≥ 1000 CAC score subgroup, respectively. In multivariable analysis CAC score was the only determinant that significantly predicted the presence of inducible myocardial ischemia on CTP. CONCLUSIONS In a population of symptomatic patients, the majority of patients with extensive calcification had evidence of inducible myocardial ischemia on CTP. CAC score was the only independent predictor of inducible myocardial ischemia on CTP.
Collapse
Affiliation(s)
- Mohammed El Mahdiui
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Jeff M Smit
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Arthur J H A Scholte
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| |
Collapse
|
50
|
Trpkov C, Savtchenko A, Liang Z, Feng P, Southern DA, Wilton SB, James MT, Feil E, Mylonas I, Miller RJH. Visually estimated coronary artery calcium score improves SPECT-MPI risk stratification. IJC HEART & VASCULATURE 2021; 35:100827. [PMID: 34195354 PMCID: PMC8233133 DOI: 10.1016/j.ijcha.2021.100827] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/30/2021] [Accepted: 06/10/2021] [Indexed: 12/13/2022]
Abstract
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.
Collapse
Affiliation(s)
- Cvetan Trpkov
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Alexei Savtchenko
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Zhiying Liang
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Patrick Feng
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Danielle A Southern
- Department of Medicine, Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen B Wilton
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Matthew T 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
| | - Erin Feil
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Ilias Mylonas
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Robert J H Miller
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, AB, Canada
| |
Collapse
|