scholarly journals Predictors of 18F-sodium fluoride uptake in patients with stable coronary artery disease and adverse plaque features on computed tomography angiography

2019 ◽  
Vol 21 (1) ◽  
pp. 58-66 ◽  
Author(s):  
Jacek Kwiecinski ◽  
Damini Dey ◽  
Sebastien Cadet ◽  
Sang-Eun Lee ◽  
Balaji Tamarappoo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Sodium Fluoride ◽  
Computed Tomography Angiography ◽  
Stable Coronary Artery Disease ◽  
Qualitative And Quantitative ◽  
Fluoride Uptake ◽  
Artery Disease

Abstract Aims In patients with stable coronary artery disease (CAD) and high-risk plaques (HRPs) on coronary computed tomography angiography (CTA), we sought to define qualitative and quantitative CTA predictors of abnormal coronary 18F-sodium fluoride uptake (18F-NaF) by positron emission tomography (PET). Methods and results Patients undergoing coronary CTA were screened for HRP. Those who presented with ≥3 CTA adverse plaque features (APFs) including positive remodelling; low attenuation plaque (LAP, <30 HU), spotty calcification; obstructive coronary stenosis ≥50%; plaque volume >100 mm3 were recruited for 18F-NaF PET. In lesions with stenosis ≥25%, quantitative plaque analysis and maximum 18F-NaF target to background ratios (TBRs) were measured. Of 55 patients, 35 (64%) manifested coronary 18F-NaF uptake. Of 68 high-risk lesions 49 (70%) had increased PET tracer activity. Of the APFs, LAP had the highest sensitivity (39.4%) and specificity (98.3%) for predicting 18F-NaF uptake. TBR values were higher in lesions with LAP compared to those without [1.6 (1.3–1.8) vs. 1.1 (1.0–1.3), P = 0.01]. On adjusted multivariable regression analysis, LAP (both qualitative and quantitative) was independently associated with plaque TBR [LAP qualitative: β = 0.47, 95% confidence interval (CI) 0.30–0.65; P < 0.001] and (LAP volume: β = 0.20 per 10 mm3, 95% CI 0.13–0.27; P < 0.001). Conclusion In stable CAD patients with HRP, LAP is predictive of 18F-NaF coronary uptake, but 18F-NaF is often seen in the absence of LAP. If 18F-NaF uptake is shown to be associated with adverse outcomes and becomes clinically used, the presence of LAP may define patients who would not benefit from the added testing.

Preoperative evaluation: non-invasive testing

ESC CardioMed ◽  
2018 ◽  
pp. 2646-2650
Author(s):  
Juhani Knuuti ◽  
Antti Saraste
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Myocardial Ischaemia ◽  
Computed Tomography Angiography ◽  
Perioperative Management ◽  
Obstructive Coronary Artery Disease ◽  
Non Invasive ◽  
Artery Disease

Preoperative non-invasive testing aims to provide informed choices about the appropriateness of surgery, guide perioperative management, and assess the long-term risk of a cardiac event through identification of left ventricular dysfunction, heart valve abnormalities, and myocardial ischaemia. Preoperative non-invasive testing is not recommended routinely, but it should be considered in patients in whom initial clinical evaluation indicates increased risk for perioperative cardiac complications and who are scheduled for intermediate- or high-risk surgery. Pharmacological stress testing combined with myocardial perfusion imaging or echocardiography is more suitable than physical exercise for the detection of myocardial ischaemia in patients with limited exercise tolerance that is common in the preoperative setting. Alternatively, non-invasive coronary computed tomography angiography can identify obstructive coronary artery disease. A negative stress testing with imaging or the absence of high-risk coronary anatomy on computed tomography angiography is associated with a low incidence of perioperative cardiac events, but the positive predictive value is relatively low, that is, the risk is relatively low despite a positive result. In patients with extensive stress-induced ischaemia or extensive obstructive coronary artery disease detected by non-invasive testing, individualized perioperative management is recommended considering the potential benefit of the proposed surgical procedure, weighed against the predicted risk of adverse outcome.

scholarly journals NON-INVASIVE FFR DERIVED FROM STANDARD ACQUIRED CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CTA) DATASETS (FFRCT) FOR THE DIAGNOSIS OF MYOCARDIAL ISCHEMIA IN PATIENTS WITH CORONARY ARTERY DISEASE (CAD): FIRST DATA OF CLINICAL USE. COMPARISON WITH INVASIVE MEASUREMENT

2018 ◽  
pp. 47-55 ◽  
Author(s):  
E. S. Pershina ◽  
V. E. Sinitsin ◽  
E. A. Mershina ◽  
I. M. Arkhipova ◽  
S. P. Semitko ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Stable Coronary Artery Disease ◽  
Coronary Computed Tomography ◽  
Non Invasive ◽  
Artery Disease

Objectives: to determine the diagnostic performance of non-invasive FFR derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFRCT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD).Methods.Prospective study included 16 patients ((m/f – 13/3 mean age 47.8 ± 2.3 years) with CAD and coronary stenosis 40–75% lumen reduction. Coronary CTA was performed prior to ICA with invasive FFR measurement. FFRCT was calculated and interpreted in a blinded fashion by an independent Core Laboratory (HeartFlow, USA). Results were compared to invasively measured FFR, with ischemia defined as FFRCT or FFR ≤ 0.80.Results. The area under the receiver operating characteristic curve (95% CI) for FFCT was 0.90. Per-vessel sensitivity and specificity to identify myocardial ischemia were 91% and 89% for FFRCT.Conclusion.FFRCT provides high diagnostic accuracy, and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. 

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