Gaibazzi Nicola, Suma Sergio, Garibaldi Silvia, Siniscalchi Carmine, Sartorio Daniele, Pressman Gregg, Lorenzoni Valentina
Parma University Hospital, Parma, Italy.
Parma University Hospital, Parma, Italy.
Int J Cardiol. 2020 Aug 1;312:123-128. doi: 10.1016/j.ijcard.2020.03.032. Epub 2020 Mar 12.
To determine whether calcifications of the coronary arteries (coronary artery calcium 0 to 4 score), or extending the assessment also to cardiac valves and thoracic aorta (overall calcium 0 to 8 score), as seen on computed tomography for attenuation correction during stress-scintigraphy (SPECT-CT), are associated with total mortality and non-fatal myocardial infarction. We aimed to assess whether these calcifications added to the prognostic value of SPECT imaging.
The presence/amount of calcium in the coronary arteries, but also in the heart valves and aorta, has been associated with cardiovascular (CV) and all-cause mortality. This information can be obtained during SPECT-CT examinations, where low resolution CT images are co-registered for attenuation correction of myocardial perfusion, but then discarded.
Clinical data were collected on 353 consecutive patients submitted to stress SPECT-CT between Sept 2010 and Oct 2012, for suspected coronary artery disease (CAD). Follow-up data on outcomes were collected retrospectively.
Mean age was 72 and 58% were male. Mean follow-up was 6.4 years, during which 48 subjects died (15 from CV causes) and 10 had non-fatal myocardial infarction (MI). Reversible perfusion defects were detected in 55 patients (15.6%), 39 of whom (11%) had >mild defects. The presence of a calcium score > 1 in the attenuation correction images was the strongest univariate predictor of all-cause death or MI (hazard ratio 7.21, p < .001). On multivariate analysis, controlling for age, gender and myocardial perfusion defects an overall calcium score > 2 remained a predictor of all-cause death or non-fatal MI (hazard ratio 4.12, p < .001).
Visual assessment of coronary or overall coronary, cardiac and aortic calcium in the CT images used for attenuation correction during SPECT-CT is feasible and reproducible. It was strongly associated with all-cause death and MI, even after controlling for clinical variables and myocardial perfusion data. This simple visual calcium assessment does not add additional costs or radiation, and may significantly improve risk-assessment of patients with suspected CAD undergoing SPECT-CT.
Calcium in the coronary arteries, heart valves and aorta has been associated with worse prognosis. We sought to determine whether assessment of such calcifications on computed tomography images (co-registered for myocardial perfusion attenuation correction and then discarded) are independently associated with long-term outcome on top of available data. We enrolled 353 consecutive patients, referred for suspected coronary artery disease. An overall calcium score > 1 in the attenuation correction images was the strongest univariate (hazard ratio 7.21, p < .001) and multivariate predictor of all-cause death or non-fatal MI (hazard ratio 4.12, p < .001), even after controlling for clinical variables and myocardial perfusion data.
确定在负荷心肌灌注显像（SPECT-CT）中用于衰减校正的计算机断层扫描（CT）上所显示的冠状动脉钙化（冠状动脉钙化积分0至4分），或者将评估范围扩大至心脏瓣膜和胸主动脉（总钙化积分0至8分），是否与全因死亡率和非致死性心肌梗死相关。我们旨在评估这些钙化是否增加了SPECT显像的预后价值。
冠状动脉以及心脏瓣膜和主动脉中的钙的存在/数量，与心血管（CV）和全因死亡率相关。此信息可在SPECT-CT检查期间获得，其中低分辨率CT图像用于心肌灌注的衰减校正，但随后被丢弃。
收集了2010年9月至2012年10月期间连续353例因疑似冠心病（CAD）接受负荷SPECT-CT检查的患者的临床资料。回顾性收集结局的随访数据。
平均年龄为72岁，男性占58%。平均随访6.4年，在此期间48例受试者死亡（15例死于心血管原因），10例发生非致死性心肌梗死（MI）。55例患者（15.6%）检测到可逆性灌注缺损，其中39例（11%）有>轻度缺损。衰减校正图像中钙化积分>1是全因死亡或MI的最强单因素预测指标（风险比7.21，p<0.001）。多因素分析中，在控制年龄、性别和心肌灌注缺损后，总钙化积分>2仍是全因死亡或非致死性MI的预测指标（风险比4.12，p<0.001）。
在SPECT-CT期间用于衰减校正的CT图像中对冠状动脉或冠状动脉、心脏和主动脉的总钙化进行视觉评估是可行且可重复的。即使在控制临床变量和心肌灌注数据后，它也与全因死亡和MI密切相关。这种简单的视觉钙化评估不会增加额外成本或辐射，并且可能显著改善接受SPECT-CT检查的疑似CAD患者的风险评估。
冠状动脉、心脏瓣膜和主动脉中的钙与较差的预后相关。我们试图确定在计算机断层扫描图像（用于心肌灌注衰减校正然后丢弃）上评估此类钙化是否在现有数据之上独立与长期结局相关。我们纳入了353例连续的因疑似冠状动脉疾病转诊的患者。衰减校正图像中总钙化积分>1是全因死亡或非致死性MI的最强单因素（风险比7.21，p<0.001）和多因素预测指标（风险比4.12，p<0.001），即使在控制临床变量和心肌灌注数据后也是如此。
