Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging
- 248 Downloads
A limitation of stress myocardial perfusion imaging (MPI) is the inability to detect non-obstructive coronary artery disease (CAD). One advantage of MPI with a hybrid CT device is the ability to obtain same-setting measurement of the coronary artery calcium score (CACS).
Methods and Results
Utilizing our single-center nuclear database, we identified 760 consecutive patients with: (1) no CAD history; (2) a normal clinically indicated Rb-82 PET/CT stress perfusion study; and (3) a same-setting CAC scan. 487 of 760 patients (64.1%) had subclinical CAD based on an abnormal CACS. Of those with CAC, the CACS was >100, >400, and >1000 in 47.0%, 22.4%, and 8.4% of patients, respectively. Less than half of the patients with CAC were receiving aspirin or statin medications prior to PET/CT imaging. Patients with CAC were more likely to be initiated or optimized on proven medical therapy for CAD immediately following PET/CT MPI compared to those without CAC.
Subclinical CAD is common in patients without known CAD and normal myocardial perfusion assessed by hybrid PET/CT imaging. Identification of CAC influences subsequent physician prescribing patterns such that those with CAC are more likely to be treated with proven medical therapy for the treatment of CAD.
KeywordsPET/CT imaging atherosclerosis coronary artery disease diagnostic and prognostic application myocardial perfusion imaging: PET
- 1.Husmann L, Wiegand M, Valenta I, Gaemperli O, Schepis T, Siegrist PT, et al. Diagnostic accuracy of myocardial perfusion imaging with single photon emission computed tomography and positron emission tomography: A comparison with coronary angiography. Int J Cardiovasc Imaging 2008;29:191-7.Google Scholar
- 18.Schmermund A, Denktas AE, Rumberger JA, Christian TF, Sheedy PF II, Bailey KR, et al. Independent and incremental value of coronary artery calcium for predicting the extent of angiographic coronary artery disease: Comparison with cardiac risk factors and radionuclide perfusion imaging. J Am Coll Cardiol 1999;34:777-86.CrossRefPubMedGoogle Scholar
- 24.O’Rourke RA, Brundage BH, Froelicher VF, Greenland P, Grundy SM, Hachamovitch R, et al. American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation 2000;102:126-40.PubMedGoogle Scholar
- 30.Schenker MP, Dorbala S, Hong EC, Rybicki FJ, Hachamovitch R, Kwong RY, et al. Interrelation of coronary calcification, myocardial ischemia, and outcomes in patients with intermediate likelihood of coronary artery disease: A combined positron emission tomography/computed tomography study. Circulation 2008;117:1627-9.CrossRefGoogle Scholar