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Usefulness of coronary calcium scoring to myocardial perfusion SPECT in the diagnosis of coronary artery disease in a predominantly high risk population

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Abstract

Coronary calcium scoring (CCS) adds to the diagnostic performance of myocardial perfusion single-photon emission computed tomography (SPECT) to assess the presence of significant coronary artery disease (CAD). Patients with a high pre-test likelihood are expected to have a high CCS which potentially could enhance the diagnostic performance of myocardial perfusion SPECT in this specific patient group. We evaluated the added value of CCS to SPECT in the diagnosis of significant CAD in patients with an intermediate to high pre-test likelihood. In total, 129 patients (mean age 62.7 ± 9.7 years, 65 % male) with stable anginal complaints and intermediate to high pre-test likelihood of CAD (median 87 %, range 22–95) were prospectively included in this study. All patients received SPECT and CCS imaging preceding invasive coronary angiography (CA). Fractional flow reserve (FFR) measurements were acquired from patients with angiographically estimated 50–95 % obstructive CAD. For SPECT a SSS > 3 was defined significant CAD. For CCS the optimal cut-off value for significant CAD was determined by ROC curve analysis. The reference standard for significant CAD was a FFR of <0.80 acquired by CA. Significant CAD was demonstrated in 64 patients (49.6 %). Optimal CCS cut-off value for significant CAD was >182.5. ROC curve analysis for prediction of the presence of significant CAD for SPECT, CCS and the combination of CCS and SPECT resulted in an area under the curve (AUC) of 0.88 (95 % CI 81–94), 0.75 (95 % CI 66–83 %) and 0.92 (95 % CI 87–97 %) respectively. The difference of the AUC between SPECT and the combination of CCS and SPECT was 0.05 (P = 0.12). The addition of CCS did not significantly improve the diagnostic performance of SPECT in the evaluation of patients with a predominantly high pre-test likelihood of CAD.

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Acknowledgments

The authors are very grateful for the scientific input generated by the EANM Young Investigator Meeting 2010.

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Authors and Affiliations

  1. Department of Cardiology, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands

    Jeroen Schaap, Robert M. Kauling, Martijn C. Post, Jan A. Van der Heyden & Benno J. W. M. Rensing

  2. Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands

    Jeroen Schaap & J. Fred Verzijlbergen

  3. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands

    S. Matthijs Boekholdt

  4. Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands

    H. Wouter van Es

  5. Department of Cardio-Thoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands

    Thom L. de Kroon

  6. Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

    J. Fred Verzijlbergen

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  1. Jeroen Schaap
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  2. Robert M. Kauling
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  3. S. Matthijs Boekholdt
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  5. Jan A. Van der Heyden
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  9. J. Fred Verzijlbergen
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Correspondence to Jeroen Schaap.

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Schaap, J., Kauling, R.M., Boekholdt, S.M. et al. Usefulness of coronary calcium scoring to myocardial perfusion SPECT in the diagnosis of coronary artery disease in a predominantly high risk population. Int J Cardiovasc Imaging 29, 677–684 (2013). https://doi.org/10.1007/s10554-012-0118-1

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  • DOI: https://doi.org/10.1007/s10554-012-0118-1

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