Visually estimated coronary artery calcium score improves SPECT-MPI risk stratification

Trpkov, Cvetan; Savtchenko, Alexei; Liang, Zhiying; Feng, Patrick L.; Southern, Danielle; Wilton, Stephen B.; James, Matthew T.; Feil, Erin; Mylonas, Ilias; Miller, Robert J.H.

doi:10.1016/j.ijcha.2021.100827

Cited by 20 publications

(7 citation statements)

References 44 publications

(56 reference statements)

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“…17,18 A major component of the prognostic power of a coronary CT angiogram rests in the identification of coronary calcifications 4,19 and coronary calcium scores can be readily obtained on many inexpensive CT scanners as well as on SPECT-CT and PET-CT instrumentation, while visually estimated coronary calcium scores can be obtained on an even larger number of non-gated chest CT scans. 20 A less critical point of criticism of the AHA/ACC chest pain document is the method for determining low likelihood vs risk: risk scores. This concept is useful in the hospitalized patient, but not as useful in the clinic setting: The guideline goes into a lot of detail about risk scores that were developed in hospital facility patients, but these are not as helpful in the office setting where risks tend to be lower and where the majority of cardiovascular diagnostic tests are ordered.…”

Section: Greater Emphasis Was Needed On the Benefits Of Multimodality Testing And Risk Score Issuementioning

confidence: 99%

ASNC’s thoughts on the AHA/ACC chest pain guidelines

Thompson

Al‐Mallah

Calnon

et al. 2022

Journal of Nuclear Cardiology

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Section: Greater Emphasis Was Needed On the Benefits Of Multimodality Testing And Risk Score Issuementioning

confidence: 99%

ASNC’s thoughts on the AHA/ACC chest pain guidelines

Thompson

Al‐Mallah

Calnon

et al. 2022

Journal of Nuclear Cardiology

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“…For patients with exercise-induced chest pain and who have a nonconclusive or normal electrocardiogram, various SPECT myocardial perfusion imaging (SPECT-MPI) scores have been developed to stratify the risks of major adverse cardiac events (MACEs). A MACE is defined as all-cause mortality, acute coronary syndrome, or revascularization more than 90 days after SPECT-MPI [3,4]. However, in one study, the sensitivity of thallium-201 scintigraphy in recognizing complicated courses of unstable angina that necessitate coronary surgery was lower than 80% [5].…”

Section: Introductionmentioning

confidence: 98%

Association of Long Noncoding RNA Expression Signatures with Stress-Induced Myocardial Perfusion Defects

et al. 2023

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Stress-induced myocardial perfusion defects found in dipyridamole–thallium-201 single-photon emission computed tomography imaging may indicate vascular perfusion abnormalities and risk of obstructive or nonobstructive coronary heart disease. Besides nuclear imaging and subsequent coronary angiography (CAG), no blood test can indicate whether dysregulated homeostasis is associated with stress-induced myocardial perfusion defects. This study investigated the expression signature of long noncoding RNAs (lncRNAs) and genes involved in vascular inflammation and stress response in the blood of patients with stress-induced myocardial perfusion abnormalities (n = 27). The results revealed an expression signature consisting of the upregulation of RMRP (p < 0.01) and downregulations of THRIL (p < 0.01) and HIF1A (p < 0.01) among patients with a positive thallium stress test and no significant coronary artery stenosis within 6 months after baseline treatment. We developed a scoring system based on the expression signatures of RMRP, MIAT, NTT, MALAT1, HSPA1A, and NLRP3 to predict the need for further CAG among patients with moderate-to-significant stress-induced myocardial perfusion defects (area under the receiver operating characteristic curve = 0.963). Therefore, we identified a dysregulated expression profile of lncRNA-based genes in the blood that could be valuable for the early detection of vascular homeostasis imbalance and personalized therapy.

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“…Thus, the extent and severity of ischemia, scar burden and left ventricular systolic function and volume can be assessed. 6 …”

Section: Introductionmentioning

confidence: 99%

“…Moreover, non-contrast CT enables the visualization of calcifications which can be leveraged to quantify coronary artery calcium (CAC). 6 The latter is considered an important biomarker and independent predictor of cardiovascular mortality and all-cause mortality in patients with CAD. Importantly, patients’ risk is stratified according to categories, with CAC scores > 400, for example, implying substantial risk of cardiovascular disease events and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Fully automated deep learning powered calcium scoring in patients undergoing myocardial perfusion imaging

Sartoretti

Gennari

Sartoretti

et al. 2023

Journal of Nuclear Cardiology

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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.

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Visually estimated coronary artery calcium score improves SPECT-MPI risk stratification

Abstract: Highlights Visually estimated coronary artery calcium was an independent predictor of MACE. VECAC provides complementary anatomic information with other SPECT-MPI markers. Physicians should consider routinely evaluating and reporting VECACS.

Cited by 20 publications

References 44 publications

ASNC’s thoughts on the AHA/ACC chest pain guidelines

ASNC’s thoughts on the AHA/ACC chest pain guidelines

Association of Long Noncoding RNA Expression Signatures with Stress-Induced Myocardial Perfusion Defects

Fully automated deep learning powered calcium scoring in patients undergoing myocardial perfusion imaging

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