Comparison of the prognostic value between quantification and visual estimation of coronary calcification from attenuation CT in patients undergoing SPECT myocardial perfusion imaging.
Comparison of the prognostic value between quantification and visual estimation of coronary calcification from attenuation CT in patients undergoing SPECT myocardial perfusion imaging.
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比较接受 SPECT 心肌灌注成像的患者中衰减 CT 冠状动脉钙化的量化和视觉估计的预后价值。
DOI：
10.1007/s10554-023-02980-1
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Slomka,PiotrJ
中科院分区：
文献类型：
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作者：
Feher,Attila;Pieszko,Konrad;Shanbhag,Aakash;Lemley,Mark;Miller,RobertJh;Huang,Cathleen;Miras,Leonidas;Liu,Yi-Hwa;Gerber,Jamie;Sinusas,AlbertJ;Miller,EdwardJ;Slomka,PiotrJ
我们研究了在SPECT/CT心肌灌注成像（MPI）期间获得的低剂量计算机断层扫描衰减校正（CTAC）扫描的视觉估计冠状动脉钙化（VECAC）的预后效用，并评估了其与CTAC（QCAC）钙评分量化的冠状动脉钙化（CAC）的比较。从REFINE SPECT登记研究中，纳入了4，236例既往未接受过冠状动脉支架植入术且在单中心进行SPECT/CT检查的患者（年龄：64 ± 12岁，47%为女性）。每个冠状动脉（左主干、左前降支、回旋支和右冠状动脉）的VECAC分别评分为0（无）、1（轻度）、2（中度）或3（重度），每个患者的评分可能为0- 1 - 2（总体VECAC等级0：0，轻度：1-2，中度：3-5，重度：>5）。CTAC的CAC评分在REFINE SPECT核心实验室使用专用软件进行。VECAC与分类QCAC相关（0：0，轻度：1-99，中度：100-399，重度：≥400）。VECAC和QCAC之间存在高度相关性，73%的VECAC与QCAC属于同一类别，98%属于同一类别。VECAC和QCAC之间存在实质性一致性（加权kappa：0.78，95%置信区间：0.76-0.79，p < 0.001）。在中位随访25个月期间，372例患者（9%）发生了主要心血管不良事件（MACE）。在生存分析中，VECAC和QCAC均与MACE相关。与QCAC相比，VECAC的2年MACE受试者工作特征曲线下面积相似（0.694 vs 0.691，p = 0.70）。总之，低剂量CTAC扫描的CAC视觉评估提供了接受SPECT/CT MPI的患者的QCAC的良好估计。与QCAC相比，目视评估的CAC对MACE具有相似的预后价值。
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.