CT attenuation correction improves quantitative risk prediction by cardiac SPECT in obese patients

Attila Feher, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA. attila.feher@yale.edu.
Konrad Pieszko, Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Aakash Shanbhag, Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Mark Lemley, Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Bryan Bednarski, Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.Follow
Robert J. Miller, Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Cathleen Huang, Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Leonidas Miras, Division of Cardiology, Bridgeport Hospital, Yale University School of Medicine, Bridgeport, CT, USA.
Yi-Hwa Liu, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA.
Albert J. Sinusas, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA.
Piotr J. Slomka, Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Edward J. Miller, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA.

Document Type

Article

Publication Title

European journal of nuclear medicine and molecular imaging

Abstract

PURPOSE: This study aimed to compare the predictive value of CT attenuation-corrected stress total perfusion deficit (AC-sTPD) and non-corrected stress TPD (NC-sTPD) for major adverse cardiac events (MACE) in obese patients undergoing cadmium zinc telluride (CZT) SPECT myocardial perfusion imaging (MPI). METHODS: The study included 4,585 patients who underwent CZT SPECT/CT MPI for clinical indications (chest pain: 56%, shortness of breath: 13%, other: 32%) at Yale New Haven Hospital (age: 64 ± 12 years, 45% female, body mass index [BMI]: 30.0 ± 6.3 kg/m, prior coronary artery disease: 18%). The association between AC-sTPD or NC-sTPD and MACE defined as the composite end point of mortality, nonfatal myocardial infarction or late coronary revascularization (> 90 days after SPECT) was evaluated with survival analysis. RESULTS: During a median follow-up of 25 months, 453 patients (10%) experienced MACE. In patients with BMI ≥ 35 kg/m (n = 931), those with AC-sTPD ≥ 3% had worse MACE-free survival than those with AC-sTPD < 3% (HR: 2.23, 95% CI: 1.40 - 3.55, p = 0.002) with no difference in MACE-free survival between patients with NC-sTPD ≥ 3% and NC-sTPD < 3% (HR:1.06, 95% CI:0.67 - 1.68, p = 0.78). AC-sTPD had higher AUC than NC-sTPD for the detection of 2-year MACE in patients with BMI ≥ 35 kg/m (0.631 versus 0.541, p = 0.01). In the overall cohort AC-sTPD had a higher ROC area under the curve (AUC, 0.641) than NC-sTPD (0.608; P = 0.01) for detection of 2-year MACE. In patients with BMI ≥ 35 kg/m AC sTPD provided significant incremental prognostic value beyond NC sTPD (net reclassification index: 0.14 [95% CI: 0.20 - 0.28]). CONCLUSIONS: AC sTPD outperformed NC sTPD in predicting MACE in patients undergoing SPECT MPI with BMI ≥ 35 kg/m. These findings highlight the superior prognostic value of AC-sTPD in this patient population and underscore the importance of CT attenuation correction.

First Page

695

Last Page

706

DOI

10.1007/s00259-023-06484-x

Publication Date

2-1-2024

Identifier

37924340 (pubmed); NIHMS1979214 (mid); PMC11774509 (pmc); 10.1007/s00259-023-06484-x (doi); 10.1007/s00259-023-06484-x (pii)

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