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Degtiarova G, Garefa C, Boehm R, Ciancone D, Sepulcri D, Gebhard C, Giannopoulos AA, Pazhenkottil AP, Kaufmann PA, Buechel RR. Radiomics for the detection of diffusely impaired myocardial perfusion: A proof-of-concept study using 13N-ammonia positron emission tomography. J Nucl Cardiol 2023; 30:1474-1483. [PMID: 36600174 PMCID: PMC10371953 DOI: 10.1007/s12350-022-03179-y] [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: 04/18/2022] [Accepted: 11/28/2022] [Indexed: 01/06/2023]
Abstract
AIM The current proof-of-concept study investigates the value of radiomic features from normal 13N-ammonia positron emission tomography (PET) myocardial retention images to identify patients with reduced global myocardial flow reserve (MFR). METHODS Data from 100 patients with normal retention 13N-ammonia PET scans were divided into two groups, according to global MFR (i.e., < 2 and ≥ 2), as derived from quantitative PET analysis. We extracted radiomic features from retention images at each of five different gray-level (GL) discretization (8, 16, 32, 64, and 128 bins). Outcome independent and dependent feature selection and subsequent univariate and multivariate analyses was performed to identify image features predicting reduced global MFR. RESULTS A total of 475 radiomic features were extracted per patient. Outcome independent and dependent feature selection resulted in a remainder of 35 features. Discretization at 16 bins (GL16) yielded the highest number of significant predictors of reduced MFR and was chosen for the final analysis. GLRLM_GLNU was the most robust parameter and at a cut-off of 948 yielded an accuracy, sensitivity, specificity, negative and positive predictive value of 67%, 74%, 58%, 64%, and 69%, respectively, to detect diffusely impaired myocardial perfusion. CONCLUSION A single radiomic feature (GLRLM_GLNU) extracted from visually normal 13N-ammonia PET retention images independently predicts reduced global MFR with moderate accuracy. This concept could potentially be applied to other myocardial perfusion imaging modalities based purely on relative distribution patterns to allow for better detection of diffuse disease.
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Affiliation(s)
- Ganna Degtiarova
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Chrysoula Garefa
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Reto Boehm
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Domenico Ciancone
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Daniel Sepulcri
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Andreas A. Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Aju P. Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Philipp A. Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Ronny R. Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
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Suzuki Y, Matsumoto N, Yoda S, Amano Y, Okumura Y. Coronary artery calcium score: Current status of clinical application and how to handle the results. J Cardiol 2021; 79:567-571. [PMID: 34895980 DOI: 10.1016/j.jjcc.2021.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
The clinical significance of the coronary artery calcium score (CACS) has been discussed since Agatston et al. first reported its utility in 1990. CACS is less invasive and less expensive than contrast-enhanced coronary computed tomography (CT) angiography. However, to date, discussion continues on who is eligible for CACS assessment and how test results should be handled. Although the CACS cutoff value of 400 has been used in many previous studies for the detection of significant coronary artery disease (CAD) or cardiac event risk, other studies have reported that the frequency of significant ischemia, likelihood of CAD, and cardiac event rate are increasing, from mild to moderate CACS. The prognostic significance of patients with moderate CACS (1-400) is still uncertain, whereas in 2016, the Society of Cardiovascular CT and Society of Thoracic Radiology guidelines determined CACS ≥300 as moderate to severely increased risk. Another important value is CACS = 0. It is known that CACS = 0 decreases the likelihood of CAD after assessment of the pretest probability. In addition, management using statin therapy is a clinical situation that may benefit from CACS = 0. A previous study reported no significant difference in the prognosis between patients with and without statin therapy with CACS = 0. Some studies have reported the significance of the combination of CACS and noninvasive cardiac imaging, whereas CACS assessment is recommended for use in combination with risk assessment of pretest probability using clinical information including age, sex, and chest symptoms. While the utility of CACS in the management of CAD and primary prevention has been reconfirmed, the benefit of moderate values of CACS to predict prognosis with subsequent treatment and noninvasive cardiac imaging is still controversial.
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Affiliation(s)
- Yasuyuki Suzuki
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan.
| | - Shunichi Yoda
- Division of Cardiology, Department of Medicine, Nihon University, Tokyo, Japan
| | - Yasuo Amano
- Department of Radiology, Nihon University Hospital, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University, Tokyo, Japan
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Suzuki Y, Matsumoto N, Nagumo S, Matsuo R, Kuronuma K, Ashida T, Tani S, Yoda S, Amano Y, Okumura Y. Incremental Predictive Value of Coronary Calcium Score in Risk Stratification of Coronary Revascularization in Patients With Normal or Mild Ischemia Using Nuclear Myocardial Perfusion Single Photon Emission Computed Tomography. Circ J 2021; 85:877-882. [PMID: 33504711 DOI: 10.1253/circj.cj-20-0805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The incremental predictive value of the coronary artery calcium score (CACS) for risk stratification of coronary revascularization in patients with normal or mildly abnormal nuclear myocardial perfusion single photon emission computed tomography (MPS) scores is unknown. METHODS AND RESULTS We analyzed 528 patients in whom CACS was calculated and who underwent stress MPS within 3 months. Patients with known coronary artery disease, prior coronary revascularization, and those undergoing hemodialysis were excluded. Patients were followed-up with coronary revascularization based on the evidence of physiological ischemia defined by fractional flow reserve or severe coronary stenosis (≥90%). CACS was significantly associated with the summed stress score (SSS) from MPS assessment. Multivariate logistic regression analysis showed that high CACS (≥300; odds ratio [OR] 5.44, 95% confidence interval [CI] 2.28-13.0) and SSS (OR 1.29, 95% CI 1.18-1.40) were significant (P<0.001) predictors of future coronary revascularization. The log-rank test showed that high CACS stratified coronary revascularization in normal SSS (0-3; P<0.001) or mildly abnormal SSS (4-8; P=0.028) groups, whereas high CACS did not significantly stratify coronary revascularization in moderate to severe SSS (≥9; P=0.757). CONCLUSIONS Risk stratification using CACS with a cut-off value 300 may have incremental predictive value for revascularization in patients with normal or mildly abnormal MPS.
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Affiliation(s)
| | | | - Sakura Nagumo
- Department of Cardiology, Showa University Fujigaoka Hospital
| | - Rei Matsuo
- Department of Cardiology, Nihon University Hospital
| | | | | | | | - Shunichi Yoda
- Division of Cardiology, Department of Medicine, Nihon University
| | - Yasuo Amano
- Department of Radiology, Nihon University Hospital
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University
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Masoomi MA, Al-Shammeri I, Kalafallah K, Elrahman HM, Ragab O, Ahmed E, Al-Shammeri J, Arafat S. Wiener filter improves diagnostic accuracy of CAD SPECT images-comparison to angiography and CT angiography. Medicine (Baltimore) 2019; 98:e14207. [PMID: 30681596 PMCID: PMC6358408 DOI: 10.1097/md.0000000000014207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Many discrepancy in selection of proper filter and its parameters for individual cases exists. The authors investigate the impact of the most common filters on patient NM images with coronary artery disease (CAD), and compare the results with the computerized tomography (CT)-Angio and angiography for accuracy.The investigation initiated by performing various single photon emission computerized tomography (SPECT)/CT scan of the national electrical manufacturers association chest phantoms having hot and cold inserts. Data acquired on GE 670 PRO SPECT/CT; 360Ø, 64 frames, 60 seconds, low energy high resolution (LEHR) 128, low energy general purpose (LEGP) with CT attenuation (120 kV and 170 mA). The images reconstructed with filtered back projection and ITERATIVE ordered-subset expectation maximization utilizing filters; Hann, Butterworth, Metz, Hamming, and Wiener. The Image contrast was calculated to assess absolute nearness of the inserts. Based on the preliminary results, then scans of 92 patients with CAD; 64 males and 28 females, age 41 to 77 years old, who had been reported earlier reprocessed with the nominated filter and were reported by 2 NM expert. The results compared to the earlier reports and to the CT-Angio and angiography.The optimization suggested 3 filters; Wiener (Wi), Metz and Butterworth (But) provide the highest contrast (99- 66.4%) and (81- 32%) for the cold and hot inserts respectively, with the (Wi) filter to be the better option. The reprocessed patients scan with the (Wi) presented an elevated diagnostic accuracy, correlated well with the CT-Angio and angiography results (P < .001 and r = 0.79 for [Wi] and P = .004 and r = 0.39 for [But]). The percentage of the false negative for moderate to severe CAD cases reported using Wi filter reduced from 27% to 7% and similarly for mild CAD cases from 7% to 1%.It appears the Wiener filter could produce results with the highest contrast for phantom imaging of various cold and hot spheres and for the patient data which is more consistent with angiography results, with much-elevated accuracy in intermediate cases (r = 0.79 for Wiener and r = 0.39 for Butterworth vs angiography). However, the optimum parameters obtained for the filters have no relation with the resolution of the imaging system, but the details of the objects could be improved.
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Affiliation(s)
- Michael A. Masoomi
- Department of Nuclear Medicine and Molecular Imaging, Adan HospitalHadiya, KW
| | - Iman Al-Shammeri
- Department of Nuclear Medicine and Molecular Imaging, Adan HospitalHadiya, KW
| | - Khaled Kalafallah
- Department of Nuclear Medicine and Molecular Imaging, Adan HospitalHadiya, KW
- Department of Nuclear Medicine, Kuwait Cancer Control Centre, Sabah Medical District, Shuwaikh
| | - Hany M.A. Elrahman
- Department of Nuclear Medicine and Molecular Imaging, Adan HospitalHadiya, KW
| | - Osama Ragab
- Department of Nuclear Medicine and Molecular Imaging, Adan HospitalHadiya, KW
| | - Ebba Ahmed
- Department of Nuclear Medicine and Molecular Imaging, Adan HospitalHadiya, KW
| | - Jehan Al-Shammeri
- Department of Nuclear Medicine, Faculty of Medicine, Heath Science Centre, Kuwait University
| | - Sharif Arafat
- Department of Cardiology, Dabbous Cardiac Centre, Adan Hospital, Hadiya, Kuwait
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Yokota S, Ottervanger JP, Mouden M, de Boer MJ, Jager PL, Timmer JR. Predictors of severe stenosis at invasive coronary angiography in patients with normal myocardial perfusion imaging. Neth Heart J 2018; 26:192-202. [PMID: 29500790 PMCID: PMC5876173 DOI: 10.1007/s12471-018-1091-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose Normal myocardial perfusion imaging (MPI) is associated with excellent prognosis. However, in patients with persisting symptoms, it may be difficult to determine the patients in whom invasive angiography is justified to rule out false negative MPI. We evaluated predictors for severe stenosis at invasive angiography in patients with persisting symptoms after normal MPI. Methods 229 consecutive patients with normal MPI, without previous bypass surgery, underwent invasive angiography within 6 months. Older age was defined as >65 years. Multivariable analyses were performed to adjust for differences in baseline variables. Results Mean age was 62 ± 11 years, 48% were women. Severe stenosis was observed in 34%, and of these patients 60% had single-vessel disease (not left main coronary artery disease). After adjusting for several variables, including diabetes, smoking status, hypertension and hypercholesterolaemia, predictors of severe stenosis were male gender, odds ratio (OR) 2.7 (95% confidence interval (CI) 1.5–4.9), older age, OR 1.9 (95% CI 1.02–3.54) previous PCI, OR 2.0 (95% CI 1.0–4.3) and typical angina, OR 2.5 (95% CI 1.4–4.6). Conclusions Increasing age, male gender, previous PCI and typical symptoms are predictors of severe stenosis at invasive coronary angiography in patients with normal MPI. The majority of these patients have single-vessel disease.
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Affiliation(s)
- S Yokota
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - J P Ottervanger
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands.
| | - M Mouden
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - M J de Boer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P L Jager
- Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands
| | - J R Timmer
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
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Nakanishi R, Gransar H, Slomka P, Arsanjani R, Shalev A, Otaki Y, Friedman JD, Hayes SW, Thomson LEB, Fish M, Germano G, Abidov A, Shaw L, Rozanski A, Berman DS. Predictors of high-risk coronary artery disease in subjects with normal SPECT myocardial perfusion imaging. J Nucl Cardiol 2016; 23:530-41. [PMID: 25971987 PMCID: PMC6377163 DOI: 10.1007/s12350-015-0150-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/30/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND While uncommon, normal stress SPECT myocardial perfusion imaging (MPI) can be seen in patients with high-risk coronary artery disease (CAD) by invasive coronary angiography (ICA).The predictors of high-risk CAD in patients with normal SPECT-MPI have not been described. METHODS We studied 580 patients (age 64 ± 12 years, 49% men) without known CAD who underwent stress-gated SPECT-MPI [exercise (41%) or vasodilator (59%)] <2 months before ICA and had summed stress score (SSS) <4. High-risk CAD was defined as 3 vessels with ≥70% stenosis, 2 vessels with ≥70% stenosis including proximal left anterior descending, or left main with ≥50% stenosis. Obstructive non-high-risk CAD was defined by the presence of a ≥70% stenosis but without having other high-risk criteria. Tenfold cross-validated receiver operating characteristic (ROC) estimates were obtained to assess the predictors of high-risk CAD. RESULTS Forty-two subjects (7.2%) had high-risk CAD and 168 (29.0%) had obstructive non-high-risk CAD. Variables associated with high-risk CAD were pretest probability of CAD ≥66% (Odds ratio [OR] 3.63, 95% CI 1.6-8.3, P = .002), SSS > 0 (OR 7.46, 95% CI 2.6-21.1, P < 0.001), and abnormal TID (OR 2.16, 95% CI 1.0-4.5, P = 0.044). When substituted for TID, EF change was also predictive of high-risk CAD (OR 0.93, 95% CI 0.9-1.0, P = 0.023). The prevalence of high-risk CAD increased as the number of these predictors increased. In a sub-analysis of patients in whom quantitative total perfusion deficit (TPD) was available, TPD > 0 was also a predictor of high-risk CAD (OR 6.01, 95% CI 1.5-22.2, P = 0.011). CONCLUSION Several clinical, stress, and SPECT-MPI findings are associated high-risk CAD among patients with normal SPECT-MPI. Consideration of these factors may improve the overall assessment of the likelihood of high-risk CAD in patients undergoing stress SPECT-MPI.
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Affiliation(s)
- Rine Nakanishi
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Heidi Gransar
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Piotr Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Reza Arsanjani
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Aryeh Shalev
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Yuka Otaki
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - John D Friedman
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Sean W Hayes
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Louise E B Thomson
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Mathews Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Guido Germano
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Aiden Abidov
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Leslee Shaw
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Alan Rozanski
- Division of Cardiology, St. Luke's Roosevelt Hospital, New York, NY, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Yuoness SA, Goha AM, Romsa JG, Akincioglu C, Warrington JC, Datta S, Massel DR, Martell R, Gambhir S, Urbain JLC, Vezina WC. Very high coronary artery calcium score with normal myocardial perfusion SPECT imaging is associated with a moderate incidence of severe coronary artery disease. Eur J Nucl Med Mol Imaging 2015; 42:1542-50. [PMID: 26138459 PMCID: PMC4521098 DOI: 10.1007/s00259-015-3072-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 04/15/2015] [Indexed: 01/07/2023]
Abstract
PURPOSE Myocardial perfusion imaging (MPI) has limitations in the presence of balanced multivessel disease (MVD) and left main (LM) coronary artery disease, occasionally resulting in false-normal results despite the high cardiovascular risk associated with this condition. The purpose of this study was to assess the incidence of severe coronary artery disease (CAD) in the presence of a very high Agatston coronary artery calcium (CAC) score (>1,000) in stable symptomatic patients without known CAD but with normal MPI results. METHODS A total of 2,659 prospectively acquired consecutive patients were referred for MPI and evaluation of CAC score by CT. Of this patient population, 8 % (222/2,659) had ischemia without myocardial infarction (MI) on MPIand 11 % (298/2,659) had abnormal MPI (MI and/or ischemia). On presentation 1 % of the patients (26/2,659) were symptomatic, had a CAC score >1,000 and normal MPI results. The definition of normal MPI was strict and included a normal hemodynamic response without ischemic ECG changes and normal imaging, particularly absence of transient ischemic dilation. All of these 26 patients with a CAC score >1,000 and normal MPI findings underwent cardiac catheterization. RESULTS Of these 26 patients, 58 % (15/26) had severe disease (≥70 % stenosis) leading to revascularization. Of this group, 47 % (7/15) underwent percutaneous intervention, and 53 % (8/15) underwent coronary artery bypass grafting. All of these 15 patients had either MVD (14/15) or LM coronary artery disease (1/15), and represented 0.6 % (15/2,659) of all referred patients (95 % CI 0.3 - 0.9 %). The majority, 90 % (8/9), had severe CAD with typical chest pain. CONCLUSION A very high CAC score (>1,000) with normal MPI in a small subset of symptomatically stable patients was associated with a moderate incidence of severe CAD (95 % CI 37 - 77 %). Larger studies and/or a meta-analysis of small studies are needed to more precisely estimate the incidence of CAD in this population. This study also supports the concept that a normal MPI result in patients with severe CAD may be due to balanced MVD.
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Affiliation(s)
- Salem A Yuoness
- Department of Nuclear Medicine, London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, ON, N6A 5W9, Canada
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Aziz EF, Javed F, Alviar CL, Herzog E. Triple vessel coronary artery disease presenting as a markedly positive stress electrocardiographic test and a negative SPECT-TL scintigram: a case of balanced ischemia. Heart Int 2011; 6:e22. [PMID: 22355489 PMCID: PMC3282439 DOI: 10.4081/hi.2011.e22] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 09/05/2011] [Accepted: 10/25/2011] [Indexed: 11/23/2022] Open
Abstract
The presence of false negative nuclear stress test in the settings of positive electrocardiographic changes is a very unusual phenomenon and is usually secondary to balanced ischemia of the myocardial segments evaluated by SPECT-TL. We present a case of an 81-year old post-menopausal female who presented to her primary care physician for evaluation of a 6-week dyspnea on exertion and was referred to our institution for exercise stress test with Thallium SPECT with the objective of ruling out coronary artery disease and identifying possible areas of myocardial ischemia. The resting electrocardiogram was unremarkable and stress test evaluation was made. The patient was admitted to the cardiac care unit and coronary artery bypass grafting was successfully performed. The presence of false negative nuclear stress test in the settings of positive electrocardiographic changes is a very unusual phenomenon and is usually secondary to balanced ischemia of the myocardial segments evaluated by SPECT-TL. Patients undergoing stress tests with these characteristics should undergo careful evaluation and a high level of suspicion should be adopted for further diagnostic assessment of coronary artery disease.
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Affiliation(s)
- Emad F Aziz
- The ACAP Program; St. Luke's - Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Kiriyama T, Toba M, Fukushima Y, Hayashi H, Takano H, Mizuno K, Kumita SI. Discordance Between the Morphological and Physiological Information of 64-Slice MSCT Coronary Angiography and Myocardial Perfusion Imaging in Patients With Intermediate to High Probability of Coronary Artery Disease. Circ J 2011; 75:1670-7. [DOI: 10.1253/circj.cj-10-1123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tomonari Kiriyama
- Department of Radiology, Graduate School of Radiology, Nippon Medical School
| | - Masahiro Toba
- Department of Radiology, Graduate School of Radiology, Nippon Medical School
| | | | - Hiromitsu Hayashi
- Department of Radiology, Graduate School of Radiology, Nippon Medical School
| | - Hitoshi Takano
- Department of Internal Medicine (Division of Cardiology, Hepatology, Geriatrics, and Integrated Medicine), Nippon Medical School
| | - Kyoichi Mizuno
- Department of Internal Medicine (Division of Cardiology, Hepatology, Geriatrics, and Integrated Medicine), Nippon Medical School
| | - Shin-ichiro Kumita
- Department of Radiology, Graduate School of Radiology, Nippon Medical School
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Jang SJ, Chu CM, Yang TY, Lin YS, Tsai MF, Chang ST. Coronary artery phenotypes in subjects with negative myocardial perfusion imaging and typical angina pectoris. Am J Med Sci 2010; 340:350-5. [PMID: 20724904 DOI: 10.1097/maj.0b013e3181ee2f4e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Limited data are available on coronary lesion morphology for patients with false-negative radionuclide findings together with typical angina symptoms. METHODS The study group consisted of 25 subjects with a negative pharmacological thallium (Tl)-201 single-photon emission computed tomography perfusion imaging study but typical angina symptoms and coronary artery disease (CAD) confirmed by coronary angiography. The control group included 690 subjects with a positive pharmacological Tl-201 single-photon emission computed tomography study and CAD. RESULTS The study group showed a significantly older and higher female ratio than the control group. Significant differences were found between the 2 groups in the presence of current smoking status and hypertension. A noticeably higher percentage of positive metabolic syndrome ratio, number of metabolic syndrome components, high waist-to-hip ratio percentage and high waist circumference percentage in the study group. The study group was noticeably lower in mean numbers of culprit vessel involvement and mean lesion numbers than the control group. There were more individuals with type A classification and a lower proportion of complex stenoses--which contain type B2 and C lesions--in the study group than in the control group. The study group had significantly fewer calcified stenoses and complex morphology stenoses--the latter of which include lesion morphologies with chronic total occlusion, diffuse and calcification--than the control group. CONCLUSIONS For the high probability of CAD lesions that requires interventional therapy, patients with negative myocardial scintigraphy but typical angina symptoms would be beneficial to intensive medical treatment and coronary study.
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Affiliation(s)
- Shih-Jung Jang
- Division of Cardiology, Chiayi Chang Gung Memorial Hospital, Chiayi Hsien, Taiwan
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van Werkhoven JM, Schuijf JD, Jukema JW, Kroft LJ, Stokkel MP, Dibbets-Schneider P, Pundziute G, Scholte AJ, van der Wall EE, Bax JJ. Anatomic correlates of a normal perfusion scan using 64-slice computed tomographic coronary angiography. Am J Cardiol 2008; 101:40-5. [PMID: 18157963 DOI: 10.1016/j.amjcard.2007.07.046] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 07/09/2007] [Accepted: 07/09/2007] [Indexed: 10/22/2022]
Abstract
Both myocardial perfusion imaging (MPI) and multislice computed tomography (MSCT) are currently used to detect coronary artery disease (CAD). However, MSCT permits early detection of atherosclerosis while myocardial perfusion is still normal. In addition, MPI results can be normal despite the presence of high-risk CAD (left main and balanced 3-vessel CAD). In this study, the range of anatomic findings using MSCT in patients with normal MPI results was evaluated. In 180 patients presenting with chest pain, MPI (with gated single-photon emission computed tomography) and 64-slice MSCT were performed. In patients with normal MPI results, prevalences of completely normal coronary arteries, nonobstructive CAD, and obstructive CAD were determined using MSCT. The occurrence of high-risk CAD, including left main and 3-vessel disease, was also evaluated. Normal MPI and adequate MSCT findings were obtained in 97 patients (54%; 50% women; average age 58 +/- 12 years; 5% with known CAD). A total of 38 patients (39%) showed normal coronary anatomy, whereas nonsignificant and significant CAD were observed in 37 (38%) and 18 patients (19%), respectively. Importantly, only 4 patients (4%) presented with high-risk CAD using 64-slice MSCT, 2 with left main and 2 with 3-vessel disease. In conclusion, a normal MPI result can be associated with a wide range of anatomic observations and cannot exclude the presence of both nonobstructive and obstructive CAD. However, importantly, the prevalence of high-risk CAD was rare.
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Hatanaka K, Doi M, Hirohata S, Kamikawa S, Kaji Y, Katoh T, Kusachi S, Ninomiya Y, Ohe T. Safety of and tolerance to adenosine infusion for myocardial perfusion single-photon emission computed tomography in a Japanese population. Circ J 2007; 71:904-10. [PMID: 17526988 DOI: 10.1253/circj.71.904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adenosine has been available for use in myocardial perfusion single-photon emission computed tomography (SPECT) in Japan since 2005. The purpose of this study was to evaluate the safety of and tolerance to thallium-201 myocardial perfusion SPECT with intravenous adenosine infusion in Japanese patients with suspected coronary artery disease. METHODS AND RESULTS Two hundred and six consecutive patients who underwent an adenosine infusion (120 mug . kg(-1) . min(-1)) SPECT at Sumitomo Besshi Hospital (Niihama, Japan) were investigated. The effects of adenosine infusion were monitored for each patient. A coronary angiography was performed in 81 patients. Adenosine infusion significantly decreased blood pressure and increased heart rate. Adverse reactions were observed in 161 patients (78.2%). Most reactions were transient, disappearing soon after the termination of adenosine infusion. No serious adverse reactions, such as acute myocardial infarction or death, occurred. Adenosine infusion was terminated in 3 patients (1.5%) because of near syncope or sustained 2:1 atrioventricular block. Electrocardiographic changes occurred in 15 patients (7.3%). Self-assessed scoring after SPECT showed that the patients were very tolerant (74.6% of 177 patients) of adenosine infusion myocardial SPECT. The sensitivity and specificity were 75.0% and 69.7%, respectively. CONCLUSIONS Adenosine infusion myocardial SPECT is safe and well tolerated in the Japanese population, despite the frequent occurrence of minor adverse reactions.
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Abstract
Patients with hypothyroidism have an increased risk of coronary artery disease because of significant changes in lipid metabolism and arterial hypertension. We report a 67-year-old man who developed acute myocardial infarction following hormone replacement in hypothyroidism in spite of no previous cardiac symptoms and no ischemia in intravenous dipyridamole myocardial perfusion imaging. Careful examination for ischemic heart disease should be performed before hormone replacement in hypothyroidism.
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Affiliation(s)
- Kotaro Oe
- Division of Internal Medicine, Houjukinen Hospital, Midorigaoka, Nomi, Ishikawa, Japan
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