Very high coronary artery calcium score with normal myocardial perfusion SPECT imaging is associated with a moderate incidence of severe coronary artery disease

Autor: Ahmed M. Goha, Cigdem Akincioglu, Jean-Luc Urbain, Sanjay Gambhir, Salem A. Yuoness, Jonathan Romsa, Sudip Datta, James Warrington, Rafael Martell, David Massel, William C. Vezina
Rok vydání: 2015
Předmět:
Adult
Male
medicine.medical_specialty
Comorbidity
Coronary Artery Disease
Sestamibi
Sensitivity and Specificity
Severity of Illness Index
Coronary artery disease
Myocardial perfusion imaging
Age Distribution
Risk Factors
Internal medicine
Spect imaging
Severity of illness
medicine
Humans
Radiology
Nuclear Medicine and imaging
cardiovascular diseases
Sex Distribution
Vascular Calcification
CT coronary artery calcium score
Aged
Aged
80 and over
Ontario
Tomography
Emission-Computed
Single-Photon
medicine.diagnostic_test
Coronary artery calcium score
business.industry
Incidence
Incidence (epidemiology)
Reproducibility of Results
nutritional and metabolic diseases
General Medicine
Middle Aged
medicine.disease
Causality
Radiology Nuclear Medicine and imaging
Cardiology
Female
Original Article
Radiology
Cardiology and Cardiovascular Medicine
business
Perfusion
Zdroj: European Journal of Nuclear Medicine and Molecular Imaging
ISSN: 1619-7089
1619-7070
DOI: 10.1007/s00259-015-3072-z
Popis: 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. Electronic supplementary material The online version of this article (doi:10.1007/s00259-015-3072-z) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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