CLINICAL RESEARCH: CARDIAC IMAGING
Prognostic Value of Multislice Computed Tomography and Gated Single-Photon Emission Computed Tomography in Patients With Suspected Coronary Artery Disease
Jacob M. van Werkhoven, MSc*, ,
Joanne D. Schuijf, PhD*,
Oliver Gaemperli, MD||,¶,
J. Wouter Jukema, MD, PhD*,,
Eric Boersma, MSc, PhD**,
William Wijns, MD, PhD ,
Paul Stolzmann, MD#,
Hatem Alkadhi, MD#,
Ines Valenta, MD¶,
Marcel P.M. Stokkel, MD, PhD,
Lucia J. Kroft, MD, PhD ,
Albert de Roos, MD, PhD,
Gabija Pundziute, MD*,
Arthur Scholte, MD*,
Ernst E. van der Wall, MD, PhD*,,
Philipp A. Kaufmann, MD¶, and
Jeroen J. Bax, MD, PhD, FACC*,*
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
|| Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
¶ Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
# Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
** Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
Cardiovascular Center, Aalst, Belgium
Zurich Integrative Human Physiology, University of Zurich, Zurich, Switzerland
Manuscript received September 24, 2008;
revised manuscript received October 30, 2008,
accepted October 30, 2008.
* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands (Email: j.j.bax{at}lumc.nl).
Objectives: This study was designed to determine whether multislice computed tomography (MSCT) coronary angiography has incremental prognostic value over single-photon emission computed tomography myocardial perfusion imaging (MPI) in patients with suspected coronary artery disease (CAD).
Background: Although MSCT is used for the detection of CAD in addition to MPI, its incremental prognostic value is unclear.
Methods: In 541 patients (59% male, age 59 ± 11 years) referred for further cardiac evaluation, both MSCT and MPI were performed. The following events were recorded: all-cause death, nonfatal infarction, and unstable angina requiring revascularization.
Results: In the 517 (96%) patients with an interpretable MSCT, significant CAD (MSCT  50% stenosis) was detected in 158 (31%) patients, and abnormal perfusion (summed stress score [SSS]: 4) was observed in 168 (33%) patients. During follow-up (median 672 days; 25th, 75th percentile: 420, 896), an event occurred in 23 (5.2%) patients. After correction for baseline characteristics in a multivariate model, MSCT emerged as an independent predictor of events with an incremental prognostic value to MPI. The annualized hard event rate (all-cause mortality and nonfatal infarction) in patients with none or mild CAD (MSCT <50% stenosis) was 1.8% versus 4.8% in patients with significant CAD (MSCT 50% stenosis). A normal MPI (SSS <4) and abnormal MPI (SSS 4) were associated with an annualized hard event rate of 1.1% and 3.8%, respectively. Both MSCT and MPI were synergistic, and combined use resulted in significantly improved prediction (log-rank test p value <0.005).
Conclusions: MSCT is an independent predictor of events and provides incremental prognostic value to MPI. Combined anatomical and functional assessment may allow improved risk stratification.
Key Words: imaging • atherosclerosis • perfusion • prognosis
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | CS = coronary artery calcium score | | ECG = electrocardiogram | | MPI = myocardial perfusion imaging | | MSCT = multislice computed tomography coronary angiography | | SPECT = single-photon emission computed tomography | | SSS = summed stress score |
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ehr346v1.
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58(8):
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|
|
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58(5):
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|
|
|
|
|
|
|
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4(7):
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|
|
|
|
|
|
|
B. Tamarappoo and R. Hachamovitch
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52(7):
1079 - 1086.
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|
|
|
|
|
|
|
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57(24):
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|
|
|
|
|
|
|
A. P. Pazhenkottil, R. N. Nkoulou, J.-R. Ghadri, B. A. Herzog, R. R. Buechel, S. M. Kuest, M. Wolfrum, M. Fiechter, L. Husmann, O. Gaemperli, et al.
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32(12):
1465 - 1471.
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[Full Text]
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|
|
|
|
|
|
|
C. L. Schlett, D. Banerji, E. Siegel, F. Bamberg, S. J. Lehman, M. Ferencik, T. J. Brady, J. T. Nagurney, U. Hoffmann, and Q. A. Truong
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4(5):
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|
|
|
|
|
|
|
V. L. Priest, P. A. Scuffham, R. Hachamovitch, and T. H. Marwick
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4(5):
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|
|
|
|
|
|
|
E. A. Hulten, S. Carbonaro, S. P. Petrillo, J. D. Mitchell, and T. C. Villines
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J. Am. Coll. Cardiol.,
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57(10):
1237 - 1247.
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|
|
|
|
|
|
|
J. E. van Velzen, J. D. Schuijf, F. R. de Graaf, E. Boersma, G. Pundziute, F. Spano, M. J. Boogers, M. J. Schalij, L. J. Kroft, A. de Roos, et al.
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32(5):
637 - 645.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Schuijf, S. Achenbach, P. J. de Feyter, and J. J. Bax
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97(4):
330 - 337.
[Full Text]
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|
|
|
|
|
|
|
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4(2):
191 - 202.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. van Werkhoven, J. D. Schuijf, A. P. Pazhenkottil, B. A. Herzog, J. R. Ghadri, J. W. Jukema, E. Boersma, L. J. Kroft, A. de Roos, P. A. Kaufmann, et al.
Influence of smoking on the prognostic value of cardiovascular computed tomography coronary angiography
Eur. Heart J.,
February 1, 2011;
32(3):
365 - 370.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Blankstein and A. D. DeVore
Selecting a Noninvasive Imaging Study After an Inconclusive Exercise Test
Circulation,
October 12, 2010;
122(15):
1514 - 1518.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Van Werkhoven, F. Cademartiri, S. Seitun, E. Maffei, A. Palumbo, C. Martini, G. Tarantini, L. J. Kroft, A. de Roos, A. C. Weustink, et al.
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Radiology,
July 1, 2010;
256(1):
83 - 92.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. B. Mark, D. S. Berman, M. J. Budoff, J. J. Carr, T. C. Gerber, H. S. Hecht, M. A. Hlatky, J. M. Hodgson, M. S. Lauer, J. M. Miller, et al.
ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents
J. Am. Coll. Cardiol.,
June 8, 2010;
55(23):
2663 - 2699.
[Full Text]
[PDF]
|
|
|
|
|
|
|
WRITING COMMITTEE MEMBERS, D. B. Mark, D. S. Berman, M. J. Budoff, J. J. Carr, T. C. Gerber, H. S. Hecht, M. A. Hlatky, J. M. Hodgson, M. S. Lauer, et al.
ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents
Circulation,
June 8, 2010;
121(22):
2509 - 2543.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. K. Min, F. Y. Lin, A. M. Dunning, A. Delago, J. Egan, L. J. Shaw, D. S. Berman, and T. Q. Callister
Incremental prognostic significance of left ventricular dysfunction to coronary artery disease detection by 64-detector row coronary computed tomographic angiography for the prediction of all-cause mortality: results from a two-centre study of 5330 patients
Eur. Heart J.,
May 2, 2010;
31(10):
1212 - 1219.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. K. Min, L. J. Shaw, and D. S. Berman
The Present State of Coronary Computed Tomography Angiography: A Process in Evolution
J. Am. Coll. Cardiol.,
March 9, 2010;
55(10):
957 - 965.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. K. Min, R. Hachamovitch, A. Rozanski, L. J. Shaw, D. S. Berman, and R. Gibbons
Clinical Benefits of Noninvasive Testing: Coronary Computed Tomography Angiography as a Test Case
J. Am. Coll. Cardiol. Img.,
March 1, 2010;
3(3):
305 - 315.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. F. Tops, M. J. Schalij, and J. J. Bax
Imaging and atrial fibrillation: the role of multimodality imaging in patient evaluation and management of atrial fibrillation
Eur. Heart J.,
March 1, 2010;
31(5):
542 - 551.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. van Werkhoven, M. W. Heijenbrok, J. D. Schuijf, J. W. Jukema, E. E. van der Wall, J. H. M. Schreur, and J. J. Bax
Combined non-invasive anatomical and functional assessment with MSCT and MRI for the detection of significant coronary artery disease in patients with an intermediate pre-test likelihood
Heart,
March 1, 2010;
96(6):
425 - 431.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. J. Gibbons, P. A. Araoz, and E. E. Williamson
The Year in Cardiac Imaging
J. Am. Coll. Cardiol.,
February 2, 2010;
55(5):
483 - 495.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. S. Javadi, R. Lautamaki, J. Merrill, C. Voicu, W. Epley, G. McBride, and F. M. Bengel
Definition of Vascular Territories on Myocardial Perfusion Images by Integration with True Coronary Anatomy: A Hybrid PET/CT Analysis
J. Nucl. Med.,
February 1, 2010;
51(2):
198 - 203.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J E van Velzen, J D Schuijf, F R de Graaf, G Nucifora, G Pundziute, J W Jukema, M J Schalij, L J Kroft, A de Roos, J H C Reiber, et al.
Plaque type and composition as evaluated non-invasively by MSCT angiography and invasively by VH IVUS in relation to the degree of stenosis
Heart,
December 15, 2009;
95(24):
1990 - 1996.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. van Werkhoven, J. D. Schuijf, O. Gaemperli, J. W. Jukema, L. J. Kroft, E. Boersma, A. Pazhenkottil, I. Valenta, G. Pundziute, A. de Roos, et al.
Incremental prognostic value of multi-slice computed tomography coronary angiography over coronary artery calcium scoring in patients with suspected coronary artery disease
Eur. Heart J.,
November 1, 2009;
30(21):
2622 - 2629.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J M van Werkhoven, O Gaemperli, J D Schuijf, J W Jukema, L J Kroft, S Leschka, H Alkadhi, I Valenta, G Pundziute, A de Roos, et al.
Multislice computed tomography coronary angiography for risk stratification in patients with an intermediate pretest likelihood
Heart,
October 1, 2009;
95(19):
1607 - 1611.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Djaberi, J. D. Schuijf, E. Boersma, L. J.M. Kroft, A. M. Pereira, J. A. Romijn, A. J. Scholte, J. W. Jukema, and J. J. Bax
Differences in Atherosclerotic Plaque Burden and Morphology Between Type 1 and 2 Diabetes as Assessed by Multislice Computed Tomography
Diabetes Care,
August 1, 2009;
32(8):
1507 - 1512.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Anatomic Imaging, Functional Imaging, or Both in Suspected Coronary Disease?
Journal Watch (General),
April 14, 2009;
2009(414):
2 - 2.
[Full Text]
|
|
|
|
|
|
|
P. A. Kaufmann, P. G. Camici, and S. R. Underwood
CHAPTER 7 Nuclear Cardiology
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
