Detection of Myocardial Ischemia Using 64-Slice MDCT

Evaluation of myocardial viability in patients with myocardial ischemia reperfusion injury using the dual-energy CT myocardial blood pool imaging

OBJECTIVES

To evaluate myocardial viability in patients with myocardial ischemia reperfusion injury (MIRI) via dual-energy computed tomography myocardial blood pool imaging (DECT MBPI).

METHODS

Between September 2017 and January 2019, we prospectively recruited 59 patients with acute myocardial infarction (AMI) who developed MIRI after revascularization during invasive coronary angiography (ICA). Then, they received DECT MBPI, SPECT, and PET sequentially within 1 week after the onset of MIRI. A total of 1003 myocardial segments of 59 patients were recruited for this study. The iodine reduction areas and delayed enhancement areas were calculated by cardiac iodine map with SPECT rest myocardial perfusion imaging (MPI) + PET myocardial metabolism imaging (MMI) as reference criteria. The paired sample t-test was used to measure the difference of the myocardial iodine value. Cohen's Kappa analysis was used to test the consistency among different observers. ROC analysis was used to calculate the myocardial viability of DECT MBPI.

RESULTS

ROC showed the AUCs of DECT MBPI iodine value to identify a normal myocardium, an ischemic myocardium, and an infarcted myocardium were 0.957, 0.900, and 0.906 (p < 0.001). The sensitivity, specificity, and accuracy of DECT MBPI in identifying an ischemic myocardium were 87.6%, 89.3%, and 97.9% (p < 0.001). The sensitivity, specificity, and accuracy of DECT MBPI in identifying an infarcted myocardium were 88.9%, 92.2%, and 98.6% (p < 0.001). The cutoff value for DECT MBPI to differentiate between an ischemic and a normal myocardium was 0.84 mg I/mL. The cutoff value for DECT MBPI to differentiate between an infarct and a normal myocardium was 2.01 mg I/mL.

CONCLUSION

DECT MBPI can be used to assess myocardial viability in patients with MIRI with high sensitivity and specificity.

KEY POINTS

• Dual-energy computed tomography myocardial blood pool imaging (DECT MBPI) can evaluate myocardial viability of myocardial ischemia-reperfusion injury (MIRI). • DECT MBPI is a non-invasive and timesaving method for evaluation on myocardial ischemia-reperfusion injury in patients with acute myocardial infarction after coronary intervention.

Normal patterns of left ventricle rest myocardial perfusion assessed by third-generation cardiac computed tomography

PURPOSE

To investigate diastolic and systolic patterns of segmental and transmural rest perfusion of the left ventricle (LV) in normal subjects (NS) undergoing third-generation dual-source cardiac computed tomography (CCT).

METHODS

Forty consecutive NS, with normal coronary arteries and cardiac chambers both anatomically and functionally on the basis of CCT, were retrospectively enrolled in the study. Relative normalized myocardial attenuation density (rnMAD) and transmural perfusion ratio (TPR) were calculated in diastole and systole for each segment and layer of the LV and then pooled into territories.

RESULTS

Statistical analysis showed that sub-endocardial rnMAD was significantly higher than intra-myocardial and sub-epicardial for all myocardial territories both in systolic and diastolic phases (P<0·001). Basal and mid-ventricular rnMAD were higher than apical for all myocardial layers (P<0·001). Septum displayed higher rnMAD in intra-myocardium and sub-epicardium (179 ± 61 and 170 ± 59 in diastole and 172 ± 60 and 166 ± 58 in systole, respectively) than the anterior, lateral and inferior wall (P<0·001). Diastolic and systolic TPR were significantly different for the anterior and lateral wall (P<0·001), while septal TPR (1·06 ± 0·06 in diastole and 1·05 ± 0·06 in systole, respectively) was the lowest as compared to other territories' TPR. Finally, basal, mid-ventricular and apical TPR showed a significant linear trend with basal lower than mid-ventricular and apical values.

CONCLUSION

Inter-territory and inter-layer myocardial perfusion differences can be accurately assessed with CCT in NS. This assessment is the basic step to further evaluate abnormal rest perfusion patterns in ischaemic and non-ischaemic diseases.

Improved image quality at 256-slice coronary CT angiography in patients with a high heart rate and coronary artery disease: comparison with 64-slice CT imaging

BACKGROUND

The 256-slice computed tomography (CT) scanners with wider detector coverage and faster gantry rotation speed are now available. The performance of scanners that feature a rotation speed of 270 ms at coronary CT angiography (CCTA) has not been evaluated in patients with a higher heart rate.

PURPOSE

To evaluate the image quality of 256-slice CT with faster gantry rotation speed in patients undergoing CCTA.

MATERIAL AND METHODS

We enrolled 886 patients; 357(40.3%) underwent study on a 64-slice CT at a rotation speed of 420 ms, the other 529 (59.7%) were examined using a 256-slice CT scanner at 270 ms. Two observers judged the image quality of 2658 imaged coronary arteries on a 4-point scale.

RESULTS

The mean image quality score was significantly higher for the 256 - than the 64-slice CT scans (3.94 ± 0.28 vs. 3.73 ± 0.61; P < 0.01). There was no significant difference in the image quality scores between 64 - and 256-slice scans in patients whose heart rate (HR) was <60 bpm. However, in patients whose HR exceeded 60 bpm these scores were significantly higher for 256-slice CT images (P < 0.01).

CONCLUSION

CCTA performed on the 256-slice CT scanner yielded significantly better image quality in patients with an HR exceeding 60 bpm.

Myocardial blood flow quantification for evaluation of coronary artery disease by positron emission tomography, cardiac magnetic resonance imaging, and computed tomography

The noninvasive detection of the presence and functional significance of coronary artery stenosis is important in the diagnosis, risk assessment, and management of patients with known or suspected coronary artery disease. Quantitative assessment of myocardial perfusion can provide an objective and reproducible estimate of myocardial ischemia and risk prediction. Positron emission tomography, cardiac magnetic resonance, and cardiac computed tomography perfusion are modalities capable of measuring myocardial blood flow and coronary flow reserve. In this review, we will discuss the technical aspects of quantitative myocardial perfusion imaging with positron emission tomography, cardiac magnetic resonance imaging, and computed tomography, and its emerging clinical applications.

Beyond stenosis detection: computed tomography approaches for determining the functional relevance of coronary artery disease

Coronary computed tomography angiography (CCTA) is an established imaging technique for the noninvasive assessment of coronary arteries. However, CCTA remains a morphologic technique with the same limitations as invasive coronary angiography in evaluating the hemodynamic significance of coronary stenosis. Different computed tomography (CT) techniques for the functional analysis of coronary lesions have recently emerged, including static and dynamic CT myocardial perfusion imaging and CT-based fractional flow reserve and transluminal attenuation gradient methods. These techniques hold promise for achieving a comprehensive appraisal of anatomic and functional aspects of coronary heart disease with a single modality.

Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis

The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy first-pass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.

Myocardial perfusion imaging with cardiac computed tomography: state of the art

Cardiac computed tomography (CCT) has become an important tool for the anatomic assessment of patients with suspected coronary disease. Its diagnostic accuracy for detecting the presence of underlying coronary artery disease and ability to risk stratify patients are well documented. However, the role of CCT for the physiologic assessment of myocardial perfusion during resting and stress conditions is only now emerging. With the addition of myocardial perfusion imaging to coronary imaging, CCT has the potential to assess both coronary anatomy and its functional significance with a single non-invasive test. In this review, we discuss the current state of CCT myocardial perfusion imaging for the detection of myocardial ischemia and myocardial infarction and examine its complementary role to CCT coronary imaging.

Resting cardiac 64-MDCT does not reliably detect myocardial ischemia identified by radionuclide imaging

OBJECTIVE

CT myocardial perfusion imaging is an emerging diagnostic modality that is under intensive study but not yet widely used in clinical practice. The purpose of this study is to evaluate the performance of resting 64-MDCT in revealing ischemia identified on radionuclide myocardial perfusion imaging (MPI).

MATERIALS AND METHODS

We retrospectively identified 35 patients (20 women and 15 men; mean age, 52 years) with myocardial ischemia found on MPI who underwent retrospectively gated CT within 90 days of MPI. Myocardial perfusion on CT was evaluated using both a visual (n = 35) and an automated (n = 34) method. For the visual method, myocardial segments were evaluated qualitatively in systole and diastole. For the automated method, subendocardial perfusion of the standard 17 American Heart Association segments was measured using a commercially available tool in both systole and diastole. Differences between systolic and diastolic perfusion were computed.

RESULTS

Five hundred eighty myocardial segments were evaluated, 152 of which were ischemic on MPI. Visual analysis had a sensitivity of 16% (24/152), specificity of 92% (393/428), positive predictive value of 40% (24/60), and negative predictive value of 75% (392/520) in systole, and a sensitivity of 18% (27/152), specificity of 89% (382/428), positive predictive value of 37% (27/73), and negative predictive value of 75% (382/507) in diastole, as compared with MPI. There was no significant difference in subendocardial perfusion between ischemic and nonischemic segments by the automated method. There was no significant difference in CT perfusion between patients with and without obstructive coronary artery disease on CT angiography using the visual or automated methods.

CONCLUSION

Resting 64-MDCT is unsuitable for clinical use in revealing ischemia seen on MPI.

Myocardial density analysis utilizing automated myocardial defect analysis software on resting 320-detector MDCT

Cardiac CT myocardial perfusion is an emerging tool utilizing differences in myocardial density of ischemic compared to normal myocardium. We sought to document the contrast enhanced density profile of myocardial segments subtended by severely stenotic coronary arteries on rest (non stress) cardiac CT imaging, and compare the density with identical segments without ischemic disease. 100 cardiac CT studies were identified resulting in 25 normal patients, 37 with severe left anterior descending artery stenosis, 14 with severe left circumflex artery stenosis, and 24 with severe right coronary artery stenosis. The studies were reviewed on a workstation with dedicated myocardial analysis software. Left anterior descending artery ischemic segments (apical anterior and apical septal) measured 82.2 (±3) and 102 (±3) Hounsfield unit (HU) respectively comparing with non-ischemic segments 89 (±4) and 109 (±4) HU respectively (both P values 0.16). Left circumflex artery segments (basal anterolateral and mid anterolateral) demonstrated 80 (±4) and 76 (±4) HU respectively compared to non-ischemic segments, 89 (±4) and 87 (±4) HU (P value 0.13 and 0.07 respectively). Right coronary artery ischemic segments (basal inferoseptal and basal inferior) measured 104 (±3) and 105 (±3) HU respectively and these compared with non-ischemic segments, 102 (±4) and 105 (±4) HU respectively (P Value 0.69 and 0.94 respectively). Comparison of ischemic myocardial segments with non-ischemic segments demonstrated no significant difference in myocardial density. In prospectively acquired resting 320 multi detector CT, the myocardium subtended by severely stenotic vessels demonstrates no significant density difference compared with those supplied by vessels with no stenosis, confirming that myocardial ischaemia cannot be reliably detected on rest coronary computed tomography angiography by qualitative nor quantitative assessment.

Assessment of cardiac computed tomography-myocardial perfusion imaging - promise and challenges -

Cardiac computed tomography (CT) has evolved rapidly over the last decade into a reliable imaging modality for the non-invasive assessment of coronary artery disease. With the advancement in multi-detector CT technology, there has developed an increasing body of evidence that suggests that the role of cardiac CT can be extended to include functional assessment of the myocardium not only at rest but also during stress. Simultaneous anatomical and functional assessment approaches will have a number of advantages such as evaluation of the transmural extent of myocardial perfusion defects (including small subendocardial perfusion defects), reduced risk associated with multiple sources of radiation, and short image acquisition time. Although initial results hold some promise, CT myocardial perfusion imaging is a modality in the early stages of development and further work and studies are required to define, validate, and optimize this technique. This review will provide an overview of this novel perfusion imaging method, its underlying principles, evolution, limitations and future directions.

Myocardial hypo-enhancement on resting computed tomography angiography images accurately identifies myocardial hypoperfusion

OBJECTIVE

The objective of this study was to test the diagnostic accuracy of myocardial CT perfusion (CTP) imaging using color and gray-scale image analysis.

BACKGROUND

Current myocardial CTP techniques have varying diagnostic accuracy and are prone to artifacts that impair detection. This study evaluated the diagnostic accuracy of color and/or gray-scale CTP and the application of artifact criteria to detect hypoperfusion.

METHODS

Fifty-nine prospectively enrolled patients with abnormal single-photon emission computed tomography (SPECT) studies were analyzed. True hypoperfusion was defined if SPECT hypoperfusion corresponded to obstructive coronary stenoses on CT angiography (CTA). CTP applied color and gray-scale myocardial perfusion maps to resting CTA images. Criteria for identifying artifacts were also applied during interpretation.

RESULTS

Using combined SPECT plus CTA as the diagnostic standard, abnormal myocardial CTP was present in 33 (56%) patients, 19 suggesting infarction and 14 suggesting ischemia. Patient-level color and gray-scale myocardial CTP sensitivity to detect infarction was 90%, with specificity 80%, and negative and positive predictive value of 94% and 68%. To detect ischemia or infarction, CTP specificity and positive predictive value were 92% whereas sensitivity was 70%. Gray-scale myocardial CTP had slightly lower specificity but similar sensitivity. Myocardial CTP artifacts were present in 88% of studies and were identified using our criteria.

CONCLUSIONS

Color and gray-scale myocardial CTP using resting CTA images identified myocardial infarction with high sensitivity as well as infarction or ischemia with high specificity and positive predictive value without additional testing or radiation. Color and gray-scale CTP had slightly better specificity than gray-scale alone.

Myocardial perfusion defect in patients with coronary artery disease demonstrated by 64-multidetector computed tomography at rest

BACKGROUND

The first-pass imaging of 64-multidetector computed tomography (MDCT) using pharmacological stress has been used to assess myocardial perfusion. However, detection of myocardial ischemia at rest using MDCT has yet to be elucidated. We studied the incidence of myocardial perfusion defect (MPD) by 64-MDCT at rest and the effect of coronary revascularization therapy on MPD in patients with coronary artery disease.

HYPOTHESIS

MPD by 64-MDCT at rest indicates myocardial ischemia.

METHODS

We studied 76 patients with coronary artery disease who underwent 64-MDCT before and after revascularization therapy and 55 patients who did not undergo revascularization therapy. According to percent diameter stenosis, we defined group A, B, C, and D to have stenosis between 70% and 90%, 50% and 69%, 30% and 49%, and 10% and 29%, respectively. We evaluated regional myocardial contrast enhancement by long and short axis planes. MPD was defined as hypoenhancement area of some extent with CT value <50 HU during diastole.

RESULTS

MPD was found in 60.0% and 32.4% of group A and B patients, respectively (P = 0.0176). The incidence was 4.8% and 0% in group C and D patients, respectively (P<0.0001 compared with group A and B). All patients in group A and B and 2 patients with MPD in group C underwent coronary revascularization therapy. MPD disappeared after revascularization therapy in all but 3 group A patients. No patients showed new MPD after revascularization therapy.

CONCLUSIONS

Our results demonstrate that a significant percentage of patients with significant coronary artery stenosis show MPD by 64-MDCT at rest, and these MPDs may represent myocardial ischemia.

A pilot study on diagnosis of coronary artery disease using computed tomography first-pass myocardial perfusion imaging at rest

BACKGROUND

Although computed tomography coronary angiography (CTCA) can identify coronary stenosis, little data exists on the ability of multislice computed tomography (MSCT) to detect myocardial perfusion defects at rest.

METHODS

In 33 patients with diagnosed or suspected coronary artery disease (CAD), CTCA using retrospective electrocardiography (ECG) gating at rest and invasive coronary angiography (ICA) was performed. The 2D myocardial images were reconstructed in diastolic and systolic phases using the same raw data for CTCA. CT values of the myocardium were used as an estimate of myocardial enhancement, which were shown by color mapping. Myocardial ischemia was defined as a pattern of transient endocardial hypo-enhancement at systole and normal enhancement at diastole. The results of ICA were taken as the reference standard.

RESULTS

When a diameter reduction of more than 50% in ICA was used as diagnostic criteria of CAD, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT first-pass myocardial perfusion imaging (MPI) at rest were 0.85, 0.67, 0.92, and 0.50 per patient, respectively, and 0.58, 0.93, 0.85, and 0.76 per vessel, respectively.

CONCLUSIONS

CT first-pass MPI at rest could detect CAD patients, which could become a practical and convenient way to detect ischemia, consequently offering the ability for MSCT to act as a "one stop shop" for the diagnosis of CAD.

Incremental value of dual-energy CT to coronary CT angiography for the detection of significant coronary stenosis: comparison with quantitative coronary angiography and single photon emission computed tomography

To determine the value of dual-energy CT (DECT) and combined information of perfusion and angiography in diagnosing coronary artery disease (CAD), with single photon emission computed tomography (SPECT) and quantitative coronary angiography (QCA) as a reference standard. Thirty-four patients were enrolled in this study. DECT was used as a contrast-enhanced retrospectively ECG-gated scan protocol during the rest state and tubes were set at 140/100 kV. DECT angiography (DE-CTA) and DECT perfusion (DE-CTP) were calculated from two kV images. DE-CTP results were compared with SPECT and DE-CTA with QCA, respectively. The combined DE-CTP with DE-CTA data were compared to QCA in diagnosis of obstructive CAD (stenosis ≥ 50%). DECT showed diagnostic image quality in 31 patients. Using SPECT as a reference, DE-CTP had sensitivity of 68%, specificity of 93%, and sensitivity of 81%, and specificity of 92% for identifying any type of perfusion deficits on the segment- and territory-based analysis, respectively. Using QCA as a reference standard, DE-CTA showed sensitivity of 82%, specificity of 91% and accuracy of 86% for detecting ≥50% coronary stenosis on the vessel-based analysis, whereas the combination of DE-CTA and DE-CTP gave sensitivity of 90%, specificity of 86% and accuracy of 88% for detecting ≥50% coronary stenosis, respectively. Combination of DE-CTP and DE-CTA may improve diagnostic performance compared to CTA alone for the diagnosis of significant coronary stenosis.

Multidetector row computed tomography may accurately estimate plaque vulnerability: does MDCT accurately estimate plaque vulnerability? (Pro)

Over the past decade, multidetector row computed tomography (MDCT) has become the most reliable and established of the noninvasive examination techniques for detecting coronary heart disease. Now MDCT is chasing intravascular ultrasound (IVUS) in terms of spatial resolution. Among the components of vulnerable plaque, MDCT may detect lipid-rich plaque, the lipid pool, and calcified spots using computed tomography number. Plaque components are detected by MDCT with high accuracy compared with IVUS and angioscopy when assessing vulnerable plaque. The TWINS study and TOGETHAR trial demonstrated that angioscopic loss of yellow color occurred independently of volumetric plaque change by statin therapy. These 2 studies showed that plaque stabilization and regression reflect independent processes mediated by different mechanisms and time course. Noncalcified plaque and/or low-density plaque was found to be the strongest predictor of cardiac events, regardless of lesion severity, and act as a potential marker of plaque vulnerability. MDCT may be an effective tool for early triage of patients with chest pain who have a normal ECG and cardiac enzymes in the emergency department. MDCT has the potential ability to analyze coronary plaque quantitatively and qualitatively if some problems are resolved. MDCT may become an essential tool for detecting and preventing coronary artery disease in the future.

Clinical perspective of coronary computed tomographic angiography in diagnosis of coronary artery disease

Since a 4-detector row coronary computed tomographic angiography (CCTA) was launched in 1998, CCTA has experienced rapid improvement of imaging qualities with the ongoing evolution of computed tomography (CT) technology. The diagnostic accuracy of CCTA to detect coronary artery stenosis is well established, whereas improvements are still needed to reduce the overestimation of coronary artery disease (CAD) and assess plaque composition. CCTA has been used to evaluate CAD in various clinical settings. For example, CCTA could be an efficient initial triage tool at emergency departments for patients with acute chest pain with low-to-intermediate risk because of its high negative predictive value. In patients with suspected CAD, CCTA could be a cost-effective alternative to myocardial perfusion imaging and exercise electrocardiogram for the initial coronary evaluation of patients with intermediate pre-test likelihood suspected CAD. However, in asymptomatic populations, there is a lack of studies that show an improved prognostic power of CCTA over other modalities. Therefore, the clinical use of CCTA to detect CAD for purposes of risk stratification in asymptomatic individuals should be discouraged. As CT technology evolves, CCTA will provide better quality coronary imaging and non-coronary information with lower radiation exposure. Future studies should cover these ongoing technical improvements and evaluate the prognostic power of CCTA in various clinical settings of CAD in large, well-designed, randomized trials.

Dual-energy computed tomography for integrative imaging of coronary artery disease: principles and clinical applications

The introduction of coronary CT angiography (cCTA) has reinvigorated the debate whether management of patients with suspected coronary artery disease (CAD) should be primarily based on physiological, functional versus anatomical testing. Anatomical testing (i.e., cCTA or invasive catheterization) enables direct visualization and grading of coronary artery stenoses but has shortcomings for gauging the hemodynamic significance of lesions for myocardial perfusion. Rest/stress myocardial perfusion imaging (MPI) has been extensively validated for assessing the clinical significance of CAD by demonstrating fixed or reversible perfusion defects but has only limited anatomical information. There is growing evidence that contrast medium enhanced dual-energy cCTA (DECT) has potential for the comprehensive analysis of coronary artery morphology as well as changes in myocardial perfusion. DECT exploits the fact that tissues in the human body and iodine-based contrast media have unique absorption characteristics when penetrated with different X-ray energy levels, which enables mapping the iodine (and thus blood) distribution within the myocardium. The purpose of this communication is to describe the practical application of this technology for the comprehensive diagnosis of ischemic heart disease. We examine recent scientific findings in the context of current pivotal transitions in cardiovascular disease management and demonstrate the potential of cardiac DECT for the integrative assessment of patients with known or suspected CAD within a single CT-based protocol.

Clinical applications of cardiac CT angiography

ECG-gated multislice CT provides a cost-effective, non-invasive technology for evaluation of the coronary arteries, as well as for additional clinical applications, which require morphological assessment of the heart and adjacent structures with simultaneous evaluation of the coronary circulation.The excellent negative predictive value of a normal coronary CTA (cCTA) examination excludes the presence of significant coronary disease in the symptomatic patient. Triple rule-out studies provide evaluation of the aorta and pulmonary arteries without loss of image quality in the coronary circulation. The ability to visualize surrounding vascular structures along with the coronary arteries is essential in the evaluation of coronary anomalies.Cardiac CTA is useful in non-coronary applications, including evaluation of the thoracic aorta, cardiac valves and other aspects of cardiac morphology that may require surgical or percutaneous repair. Although radiation exposure is a limitation of cCTA relative to echocardiography and MRI, recent technological advances allow coronary imaging with effective doses as low as 1 mSv.Recent advances in evaluation of coronary plaque morphology as well as myocardial perfusion will allow a more complete noninvasive cardiac assessment in the future and may provide a highly effective method of cardiac risk stratification to facilitate preventive cardiac care.

Ischemic heart disease associated with bortezomib treatment combined with dexamethasone in a patient with multiple myeloma

A 79-year-old female patient with multiple myeloma who had no prior cardiac disease history developed an acute myocardial infarction on day 5 after receiving bortezomib and dexamethasone (BD). After treatment of coronary stenoses by stents, she received another course of BD therapy and developed angina pectoris on day 5 after the therapy. Bortezomib's antitumor effect is due to the inhibition of proteasome activity. This inhibition may increase endothelial progenitor cell apoptosis and decrease endothelial nitric oxide synthase/nitric oxide (eNOS/NO), thus leading to coronary spasm. It is, therefore, important to carefully monitor patients being treated with bortezomib for the potential occurrence of ischemic heart disease.

Coronary score adds prognostic information for patients with acute coronary syndrome

BACKGROUND

The aim of the present study was to explore the association of 3 coronary scores with major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS).

METHODS AND RESULTS

The 958 consecutive patients with ACS were followed up until either MACE or 31(st) December 2008 occurred; 257 patients reached clinical endpoints. Cox regression analysis demonstrated that the Gensini score was associated with 90-day MACE (relative risk (RR) 1.021, P=0.004), 6-month MACE (RR 1.021, P<0.001), 1-year MACE (RR 1.017, P=0.002), and MACE during follow-up (RR 1.010, P=0.040). Leaman score was associated with 90-day MACE (RR 1.094, P=0.014), 6-month MACE (RR 1.098, P=0.002), and 1-year MACE (RR 1.074, P=0.009). The logistic regression analysis demonstrated that the Gensini score (odds ratio (OR) 1.037, P=0.001), Leaman score (OR 1.165, P=0.007) and American College of Cardiology/American Heart Association (ACC/AHA) score (OR 1.235, P=0.025) were all associated with cardiogenic death.

CONCLUSIONS

The Gensini score provides more valuable prognostic information on cardiovascular risk than either the Leaman or ACC/AHA score in patients with ACS.