Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging

Bybee, Kevin A.; Lee, John; Markiewicz, Richard; Longmore, Ryan B.; McGhie, A. Iain; O’Keefe, James H.; Hsu, Bailing; Kennedy, Kevin F.; Thompson, Randall C.; Bateman, Timothy M.

doi:10.1007/s12350-009-9159-9

Cited by 58 publications

(25 citation statements)

References 35 publications

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“…This score applies to any combination of ITPD and CAC values, in contrast to previously proposed CAC thresholds (6,25). Consequently, the developed technique allows us to demonstrate the increase in the overall diagnostic performance of hybrid PET/ CAC in consecutive patients referred to clinically indicated MPI for suspected CAD.…”

Section: Discussionmentioning

confidence: 99%

“…PETmyocar dial perfusion imaging (MPI) is a well-established noninvasive procedure for the evaluation and risk stratification of patients with coronary artery disease (CAD) (1)(2)(3)(4)(5)(6)(7)(8). A principal advantage of hybrid PET combined with CT, compared with SPECT, is its potential ability to evaluate the coronary atherosclerotic burden as assessed by the coronary artery calcium (CAC) score during the PET scan.…”

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confidence: 99%

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Combined Quantitative Assessment of Myocardial Perfusion and Coronary Artery Calcium Score by Hybrid ⁸²Rb PET/CT Improves Detection of Coronary Artery Disease

et al. 2015

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Hybrid PET myocardial perfusion imaging (MPI) with CT allows the incorporation of coronary artery calcium (CAC) into the clinical protocol. We aimed to determine whether the combined analysis of MPI and CAC could improve the diagnostic accuracy of PET MPI in detection of obstructive coronary artery disease (CAD). Methods: Consecutive patients (n 5 152; mean age ± SD, 69 ± 12 y) without prior CAD, referred to 82 Rb PET MPI followed by invasive coronary angiography performed within 14 days, were studied. Myocardial perfusion was quantified automatically for left anterior descending, left circumflex, and right coronary artery territories as an ischemic total perfusion deficit (ITPD) for 456 vessels. Global and per-vessel CAC Agatston scores were calculated. Obstructive CAD was defined as 50% or greater stenosis of the left main and 70% or greater stenosis in the left anterior descending, left circumflex, and right coronary arteries. Logistic regression and 10-fold cross validation were used to derive and validate the combined ITPD/logCAC (logarithm of coronary calcium) scores. Results: In the prediction of per-vessel obstructive CAD, the receiver-operating-characteristic area under the curve for combined per-vessel ITPD/logCAC score was higher, 0.85 (95% confidence interval [CI], 0.81-0.89), than standalone ITPD area under the curve, 0.81 (95% CI: 0.76-0.85), and logCAC score, 0.73 (95% CI, 0.68-0.78; P , 0.05). The integrated discrimination improvement of combined per-vessel ITPD/logCAC analysis was 0.07 (95% CI, 0.04-0.09; P , 0.0001), as compared with ITPD alone. Conclusion: Combined automatically derived per-vessel ITPD and logCAC score improves accuracy of 82 Rb PET MPI for detection of obstructive CAD.Key Words: hybrid cardiac positron emission tomography; coronary calcium score; detection of obstructive coronary artery disease

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Combined Quantitative Assessment of Myocardial Perfusion and Coronary Artery Calcium Score by Hybrid ⁸²Rb PET/CT Improves Detection of Coronary Artery Disease

et al. 2015

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“…Limited data suggest that CAC influences physicians' management of CAD risk factors. 233 Although an exploratory subgroup analysis from a single randomized, clinical trial suggests that statin therapy in asymptomatic patients with CAC >400 may improve outcomes, 234 no dedicated, prospective studies have been performed to suggest that the detection of subclinical CAD by CAC leads to improvement in clinical events.…”

Section: Subclinical Cad Assessmentmentioning

confidence: 99%

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence

Fox¹,

Golden²,

Anderson³

et al. 2015

Circulation

334

131

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Abstract-Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The input provided by Drs Fox, Ershow, Nelson, and Fradkin is from their own perspective, and the opinions expressed in this article do not reflect the view of the National Institutes of Health, Department of Health and Human Services, or the US government. Dr Pignone is a member of the US Preventive Services Task Force. His contributions here represent his views alone and not necessarily those of the US Preventive Services Task Force.The American Heart Association and the American Diabetes Association make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This document was approved by the American Heart Association Science Advisory and Coordinating Committee on April 30, 2015, the American Heart Association Executive Committee on May 22, 2015, and the American Diabetes Association on January 7, 2015.The American Heart Association requests that this document be cited as follows: Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, de Boer IH, Deedwania P, Eckel RH, Ershow AG, Fradkin J, Inzucchi SE, Kosiborod M, Nelson RG, Patel MJ, Pignone M, Quinn L, Schauer PR, Selvin E, Vafiadis DK; on behalf of the American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health, Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Quality of Care and Outcomes Research, and the American Diabetes Association. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2015;132:691-718. This article has been copublished in Diabetes Care.Copies: This document is available on the World Wide Web sites of the American Heart Association (my.americanheart.org) and the American Diabetes Association (www.diabetes.org). A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the "Policies and Development" link.

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“…4 The introduction of hybrid imaging as single photon emission computed tomography (SPECT)/computed tomography (CT) and positron emission tomography/CT allows to perform morphological and functional imaging in a same study session with a comfortable accuracy. 5 A combined evaluation of functional and structural abnormalities allows to improve the detection of obstructive CAD and to better stratify patients at low-intermediate risk of CAD. 6 Previous studies demonstrated that the major predictors of events in patients with suspected CAD are the extent of atherosclerotic burden, assessed by CAC, and the extent and severity of stress-induced myocardial ischemia, as assessed by MPI.…”

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confidence: 99%

Use of coronary artery calcium scanning as a triage for invasive coronary angiography

Assante

Klain

Acampa

2019

Journal of Nuclear Cardiology

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Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging

Cited by 58 publications

References 35 publications

Combined Quantitative Assessment of Myocardial Perfusion and Coronary Artery Calcium Score by Hybrid ⁸²Rb PET/CT Improves Detection of Coronary Artery Disease

Combined Quantitative Assessment of Myocardial Perfusion and Coronary Artery Calcium Score by Hybrid ⁸²Rb PET/CT Improves Detection of Coronary Artery Disease

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence

Use of coronary artery calcium scanning as a triage for invasive coronary angiography

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Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging

Cited by 58 publications

References 35 publications

Combined Quantitative Assessment of Myocardial Perfusion and Coronary Artery Calcium Score by Hybrid 82Rb PET/CT Improves Detection of Coronary Artery Disease

Combined Quantitative Assessment of Myocardial Perfusion and Coronary Artery Calcium Score by Hybrid 82Rb PET/CT Improves Detection of Coronary Artery Disease

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence

Use of coronary artery calcium scanning as a triage for invasive coronary angiography

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Combined Quantitative Assessment of Myocardial Perfusion and Coronary Artery Calcium Score by Hybrid ⁸²Rb PET/CT Improves Detection of Coronary Artery Disease

Combined Quantitative Assessment of Myocardial Perfusion and Coronary Artery Calcium Score by Hybrid ⁸²Rb PET/CT Improves Detection of Coronary Artery Disease