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Bengs S, Haider A, Warnock GI, Fiechter M, Pargaetzi Y, Rampidis G, Etter D, Wijnen WJ, Portmann A, Osto E, Treyer V, Benz DC, Meisel A, Fuchs TA, Gräni C, Buechel RR, Kaufmann PA, Pazhenkottil AP, Gebhard C. Quantification of perivascular inflammation does not provide incremental prognostic value over myocardial perfusion imaging and calcium scoring. Eur J Nucl Med Mol Imaging 2020; 48:1806-1812. [PMID: 33200300 PMCID: PMC8113311 DOI: 10.1007/s00259-020-05106-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/01/2020] [Indexed: 01/07/2023]
Abstract
Aims Perivascular fat attenuation index (FAI) has emerged as a novel coronary computed tomography angiography (CCTA)–based biomarker predicting cardiovascular outcomes by capturing early coronary inflammation. It is currently unknown whether FAI adds prognostic value beyond that provided by single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) and CCTA findings including coronary artery calcium scoring (CACS). Methods and results A total of 492 patients (mean age 62.5 ± 10.8 years) underwent clinically indicated multimodality CCTA and electrocardiography (ECG)-gated 99mTc-tetrofosmin SPECT-MPI between May 2005 and December 2008 at our institution, and follow-up data on major adverse cardiovascular events (MACE) was obtained for 314 patients. FAI was obtained from CCTA images and was measured around the right coronary artery (FAI[RCA]), the left anterior descending artery (FAI[LAD]), and the left main coronary artery (FAI[LMCA]). During a median follow-up of 2.7 years, FAI[RCA] > − 70.1 was associated with an increased rate of MACE (log rank p = 0.049), while no such association was seen for FAI[LAD] or FAI[LMCA] (p = NS). A multivariate Cox regression model accounting for cardiovascular risk factors, CCTA and SPECT-MPI findings identified FAI[RCA] as an independent predictor of MACE (HR 2.733, 95% CI: 1.220–6.123, p = 0.015). However, FAI[RCA] was no longer a significant predictor of MACE after adding CACS (p = 0.279). A first-order interaction term consisting of sex and FAI[RCA] was significant in both models (HR 2.119, 95% CI: 1.218–3.686, p = 0.008; and HR 2.071, 95% CI: 1.111–3.861, p = 0.022). Conclusion FAI does not add incremental prognostic value beyond multimodality MPI/CCTA findings including CACS. The diagnostic value of FAI[RCA] is significantly biased by sex.
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Affiliation(s)
- Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Geoffrey I Warnock
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Michael Fiechter
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
- Swiss Paraplegic Center, 6207, Nottwil, Switzerland
| | - Yves Pargaetzi
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Georgios Rampidis
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Dominik Etter
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Winandus J Wijnen
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Elena Osto
- Institute of Clinical Chemistry, University of Zurich, 8091, Zurich, Switzerland
- University Heart Center, University Hospital Zurich, 8006, Zurich, Switzerland
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
- Institute for Regenerative Medicine, University of Zurich, 8952, Schlieren, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland
- University Heart Center, University Hospital Zurich, 8006, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland.
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland.
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