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Quantitative relationship between coronary artery calcium and myocardial blood flow by hybrid rubidium-82 PET/CT imaging in patients with suspected coronary artery disease

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

We assessed the relationship between coronary artery calcium (CAC) score, myocardial blood flow (MBF) and coronary flow reserve (CFR) in patients undergoing hybrid 82Rb positron emission tomography (PET)/computed tomography (CT) imaging for suspected CAD. We also evaluated if CAC score is able to predict a reduced CFR independently from conventional coronary risk factors.

Methods

A total of 637 (mean age 58 ± 13 years) consecutive patients were studied. CAC score was measured according to the Agatston method and patients were categorized into 4 groups (0, 0.01-99.9, 100-399.9, and ≥400). Baseline and hyperemic MBF were automatically quantified. CFR was calculated as the ratio of hyperemic to baseline MBF and it was considered reduced when <2.

Results

Global CAC score showed a significant inverse correlation with hyperemic MBF and CFR (both P < .001), while no correlation between CAC score and baseline MBF was found. At multivariable logistic regression analysis age, diabetes and CAC score were independently associated with reduced CFR (all P < .001). The addition of CAC score to clinical data increased the global chi-square value for predicting reduced CFR from 81.01 to 91.13 (P < .01). Continuous net reclassification improvement, obtained by adding CAC score to clinical data, was 0.36.

Conclusions

CAC score provides incremental information about coronary vascular function over established CAD risk factors in patients with suspected CAD and it might be helpful for identifying those with a reduced CFR.

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Abbreviations

CAC:

Coronary artery calcium

CAD:

Coronary artery disease

CFR:

Coronary flow reserve

MBF:

Myocardial blood flow

PET:

Positron emission tomography

CT:

Computed tomography

LAD:

Left anterior descending artery

LCx:

Left circumflex artery

RCA:

Right coronary artery

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Disclosure

The authors have indicated that they have no financial conflict of interest.

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Author notes

    Authors and Affiliations

    1. Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy

      Roberta Assante MD, Emilia Zampella MD, Wanda Acampa MD, PhD, Massimo Imbriaco MD & Alberto Cuocolo MD

    2. Nuclear Medicine Center, Central Manchester University Teaching Hospitals, Manchester, UK

      Parthiban Arumugam MD, Deborah Tout MD & Christine Tonge MD

    3. Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy

      Wanda Acampa MD, PhD

    4. Department of Translational Medical Sciences, University Federico II, Naples, Italy

      Mario Petretta MD

    Authors
    1. Roberta Assante MD
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    2. Emilia Zampella MD
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    3. Parthiban Arumugam MD
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    4. Wanda Acampa MD, PhD
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    5. Massimo Imbriaco MD
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    9. Alberto Cuocolo MD
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    Corresponding author

    Correspondence to Alberto Cuocolo MD.

    Additional information

    See related editorial, doi:10.1007/s12350-016-0405-7.

    Roberta Assante and Emilia Zampella have contributed equally to this work.

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    Assante, R., Zampella, E., Arumugam, P. et al. Quantitative relationship between coronary artery calcium and myocardial blood flow by hybrid rubidium-82 PET/CT imaging in patients with suspected coronary artery disease. J. Nucl. Cardiol. 24, 494–501 (2017). https://doi.org/10.1007/s12350-015-0359-1

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    • DOI: https://doi.org/10.1007/s12350-015-0359-1

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