Comparison of the prognostic value between quantification and visual estimation of coronary calcification from attenuation CT in patients undergoing SPECT myocardial perfusion imaging

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.
Robert Jh 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.
Jamie Gerber, 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.
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.
Piotr J. Slomka, Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Document Type

Article

Publication Title

The international journal of cardiovascular imaging

Abstract

We investigated the prognostic utility of visually estimated coronary artery calcification (VECAC) from low dose computed tomography attenuation correction (CTAC) scans obtained during SPECT/CT myocardial perfusion imaging (MPI), and assessed how it compares to coronary artery calcifications (CAC) quantified by calcium score on CTACs (QCAC). From the REFINE SPECT Registry 4,236 patients without prior coronary stenting with SPECT/CT performed at a single center were included (age: 64 ± 12 years, 47% female). VECAC in each coronary artery (left main, left anterior descending, circumflex, and right) were scored separately as 0 (absent), 1 (mild), 2 (moderate), or 3 (severe), yielding a possible score of 0-12 for each patient (overall VECAC grade zero:0, mild:1-2, moderate: 3-5, severe: >5). CAC scoring of CTACs was performed at the REFINE SPECT core lab with dedicated software. VECAC was correlated with categorized QCAC (zero: 0, mild: 1-99, moderate: 100-399, severe: ≥400). A high degree of correlation was observed between VECAC and QCAC, with 73% of VECACs in the same category as QCAC and 98% within one category. There was substantial agreement between VECAC and QCAC (weighted kappa: 0.78 with 95% confidence interval: 0.76-0.79, p < 0.001). During a median follow-up of 25 months, 372 patients (9%) experienced major adverse cardiovascular events (MACE). In survival analysis, both VECAC and QCAC were associated with MACE. The area under the receiver operating characteristic curve for 2-year-MACE was similar for VECAC when compared to QCAC (0.694 versus 0.691, p = 0.70). In conclusion, visual assessment of CAC on low-dose CTAC scans provides good estimation of QCAC in patients undergoing SPECT/CT MPI. Visually assessed CAC has similar prognostic value for MACE in comparison to QCAC.

First Page

185

Last Page

193

DOI

10.1007/s10554-023-02980-1

Publication Date

1-1-2024

Identifier

37845406 (pubmed); NIHMS1979222 (mid); PMC466934 (pmc); 10.1007/s10554-023-02980-1 (doi); 10.1007/s10554-023-02980-1 (pii)

This document is currently not available here.

Share

COinS