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Predictive Value of Multislice Computed Tomography Variables of Atherosclerosis for Ischemia on Stress-Rest Single Photon Emission Computed Tomography (SPECT)


van Velzen, J E; Schuijf, J D; van Werkhoven, J M; Herzog, B A; Pazhenkottil, A P; Boersma, E; de Graaf, F R; Scholte, A J; Kroft, L J; de Roos, A; Stokkel, M P; Jukema, J W; Kaufmann, P A; van der Wall, E E; Bax, J J (2010). Predictive Value of Multislice Computed Tomography Variables of Atherosclerosis for Ischemia on Stress-Rest Single Photon Emission Computed Tomography (SPECT). Circulation. Cardiovascular imaging, 3(6):718-726.

Abstract

BACKGROUND: -Previous studies have shown that the presence of stenosis alone on multislice computed tomography (MSCT) has a limited positive predictive value for the presence of ischemia on myocardial perfusion imaging (MPI). The purpose of this study was to assess which variables of atherosclerosis on MSCT angiography are related to ischemia on MPI. METHODS AND RESULTS: -Both MSCT and MPI were performed in 514 patients. On MSCT, the calcium score, degree of stenosis (>/=50% and >/=70% stenosis), plaque extent and location were determined. Plaque composition was classified as non-calcified, mixed or calcified. Ischemia was defined as a summed difference score >/=2 on a per patient basis. Ischemia was observed in 137 patients (27%). On a patient basis, multivariate analysis showed that the degree of stenosis (presence of >/=70% stenosis, OR 3.5), plaque extent and composition (mixed plaques >/=3, OR 1.7 and calcified plaques >/=3, OR 2.0) and location (atherosclerotic disease in left main coronary artery and/or proximal left anterior descending coronary artery, OR 1.6) were independent predictors for ischemia on MPI. In addition, MSCT variables of atherosclerosis such as plaque extent, composition and location had significant incremental value for the prediction of ischemia over the presence of >/=70% stenosis. CONCLUSIONS: -In addition to the degree of stenosis, MSCT variables of atherosclerosis describing plaque extent, composition and location are predictive of the presence of ischemia on MPI.

BACKGROUND: -Previous studies have shown that the presence of stenosis alone on multislice computed tomography (MSCT) has a limited positive predictive value for the presence of ischemia on myocardial perfusion imaging (MPI). The purpose of this study was to assess which variables of atherosclerosis on MSCT angiography are related to ischemia on MPI. METHODS AND RESULTS: -Both MSCT and MPI were performed in 514 patients. On MSCT, the calcium score, degree of stenosis (>/=50% and >/=70% stenosis), plaque extent and location were determined. Plaque composition was classified as non-calcified, mixed or calcified. Ischemia was defined as a summed difference score >/=2 on a per patient basis. Ischemia was observed in 137 patients (27%). On a patient basis, multivariate analysis showed that the degree of stenosis (presence of >/=70% stenosis, OR 3.5), plaque extent and composition (mixed plaques >/=3, OR 1.7 and calcified plaques >/=3, OR 2.0) and location (atherosclerotic disease in left main coronary artery and/or proximal left anterior descending coronary artery, OR 1.6) were independent predictors for ischemia on MPI. In addition, MSCT variables of atherosclerosis such as plaque extent, composition and location had significant incremental value for the prediction of ischemia over the presence of >/=70% stenosis. CONCLUSIONS: -In addition to the degree of stenosis, MSCT variables of atherosclerosis describing plaque extent, composition and location are predictive of the presence of ischemia on MPI.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
04 Faculty of Medicine > Center for Integrative Human Physiology
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Language:English
Date:2010
Deposited On:12 Nov 2010 15:20
Last Modified:05 Apr 2016 14:15
Publisher:American Heart Association
ISSN:1941-9651
Additional Information:This is an un-copyedited author manuscript that was accepted for publication in Circulation. Cardiovascular Imaging, copyright The American Heart Association. This may not be duplicated or reproduced, other than for personal use or within the “Fair Use of Copyrighted Materials” (section 107, title 17, U.S. Code) without prior permission of the copyright owner, The American Heart Association. The final copyedited article, which is the version of record, can be found at http://circimaging.ahajournals.org/. The American Heart Association disclaims any responsibility or liability for errors or omissions in this version of the manuscript or in any version derived from it by the National Institutes of Health or other parties.
Publisher DOI:10.1161/CIRCIMAGING.109.913541
PubMed ID:20660145
Permanent URL: http://doi.org/10.5167/uzh-36085

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