scholarly journals Myocardial Flow Reserve Measurement During CZT-SPECT Perfusion Imaging for Coronary Artery Disease Screening: Correlation With Clinical Findings and Invasive Coronary Angiography—The CFR-OR Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Matthieu Bailly ◽  
Frédérique Thibault ◽  
Maxime Courtehoux ◽  
Gilles Metrard ◽  
Denis Angoulvant ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Perfusion Imaging ◽  
Invasive Coronary Angiography ◽  
Flow Reserve ◽  
Artery Disease ◽  
Myocardial Flow

Purpose: The aim of this study was to assess the results of cadmium zinc telluride (CZT)- single-photon emission computed tomography (SPECT) myocardial flow reserve (MFR) in coronary artery disease (CAD) screening regarding clinical risk and its correlation to invasive coronary angiography (ICA).Methods: A total of 137 patients (61 male and 76 female) referred for CAD screening myocardial perfusion imaging (MPI) between November 2018 and April 2020 were included in the CFR-OR prospective trial. The 10-year risk of cardiovascular death according to the European Society of Cardiology (SCORE) was calculated. SPECT 1-day 99mTc-tetrofosmin protocol was acquired on CZT cardiac-dedicated pinhole cameras. Low-dose thoracic CT was used for coronary calcium score (CCS) evaluation. ICA, when performed within 3 months, was also analyzed.Results: Mean SCORE and mean global MFR were, respectively, 4 ± 3.1% and 2.50 ± 0.74; 34 patients had impaired CFR (using a threshold of 2). There was a significant inverse correlation between MFR and SCORE (p = 0.006), gender (p = 0.019), and number of cardiovascular risk factors (p = 0.01). MFR was significantly reduced in patients with CCS above 1 (p = 0.01). No significant correlation was found between MFR and individual cardiovascular risk factors (dyslipidemia, hypertension, diabetes, or family history of CAD). A total of 23 patients underwent ICA. Global MFR SPECT sensitivity and specificity were 83.3 and 100 %, respectively, with an area under the curve of 0.94.Conclusion: Adding MFR to SPECT MPI for CAD screening on CZT camera may contribute to high-risk patient identification and enhance diagnostic performances. MFR could help physician decision to perform ICA.

scholarly journals Association of Lipoprotein-Associated Phospholipase A2 with Coronary Artery Disease in African-Americans and Caucasians

2010 ◽  
Vol 95 (5) ◽  
pp. 2376-2383 ◽  
Author(s):  
Erdembileg Anuurad ◽  
Zeynep Ozturk ◽  
Byambaa Enkhmaa ◽  
Thomas A. Pearson ◽  
Lars Berglund
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
African American ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
African Americans ◽  
Coronary Angiography ◽  
Pla2 Activity ◽  
Artery Disease

Abstract Context: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is bound predominately to low-density lipoprotein and has been implicated as a risk factor for coronary artery disease (CAD). Objective: We investigated the association between Lp-PLA2 and CAD in a biethnic African-American and Caucasian population. Design: Lp-PLA2 mass, activity, and index, an integrated measure of mass and activity, and other cardiovascular risk factors were determined in 224 African-Americans and 336 Caucasians undergoing coronary angiography. Main Outcome Measures: We assessed the distribution of Lp-PLA2 levels and determined the predictive role of Lp-PLA2 as a risk factor for CAD. Results: Levels of Lp-PLA2 mass and activity were higher among Caucasians compared with African-Americans (293 ± 75 vs. 232 ± 76 ng/ml, P < 0.001 for mass and 173 ± 41 vs. 141 ± 39 nmol/min/ml, P < 0.001 for activity, respectively). However, Lp-PLA2 index was similar in the two groups (0.61 ± 0.17 vs. 0.64 ± 0.19, P = NS). In both ethnic groups, Lp-PLA2 activity and index was significantly higher among subjects with CAD. African-American subjects with CAD had significantly higher Lp-PLA2 index than corresponding Caucasian subjects (0.69 ± 0.20 vs. 0.63 ± 0.18, P = 0.028). In multivariate regression analyses, after adjusting for other risk factors, Lp-PLA2 index was independently (odds ratio 6.7, P = 0.047) associated with CAD in African-Americans but not Caucasians. Conclusions: Lp-PLA2 activity and index was associated with presence of CAD among African-Americans and Caucasians undergoing coronary angiography. The findings suggest an independent impact of vascular inflammation among African-Americans as contributory to CAD risk and underscore the importance of Lp-PLA2 as a cardiovascular risk factor.

Abstract 214: A Blood-based Precision Medicine Test Score is Additive in Determining a Patient’s Risk of Obstructive Coronary Artery Disease After Positive Myocardial Perfusion Imaging: Results From the PREDICT and COMPASS Studies

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Alexandra Lansky ◽  
John McPherson ◽  
Nic Chronos ◽  
Kari Schmitz ◽  
Jim Wingrove ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Perfusion Imaging ◽  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Precision Medicine ◽  
Perfusion Imaging ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Artery Disease

Background: Myocardial perfusion imaging (MPI) is the predominant diagnostic tool for evaluating outpatients with typical and atypical symptoms suggestive of obstructive coronary artery disease (CAD) and is commonly followed by invasive coronary angiography in patients with abnormal findings. Despite this paradigm, a significant proportion of patients do not need intervention, suggesting better diagnostic methods are needed to identify appropriate patients who would benefit from the risks, resource utilization, and healthcare costs incurred after a positive MPI. A previously validated, blood-based test incorporating age, sex and genomic expression score (ASGES) utilizing peripheral blood cell expression has demonstrated clinical validity in assessing the likelihood of obstructive CAD (≥50% luminal diameter stenosis by quantitative coronary angiography) early in the cardiac workup. Objective: The objective of this study is to evaluate if the utilization of the ASGES in conjunction with a positive MPI would assist in the determination of a patient’s risk of obstructive coronary artery disease. Methods: A total of 249 patients (mean age 58, 45% female) from 59 sites in the PREDICT (NCT00500617) and COMPASS (NCT01117506) studies were identified with a positive MPI study, defined as at least one reversible of fixed defect consistent with obstructive CAD and a subsequent invasive coronary angiography. ASGES scores were performed in all patients and were categorized into 3 groups based on score: low (1-15, 25%), mid-range (16-27, 43%) and high (28-40, 32%). Obstructive CAD rates defined by invasive coronary angiography were measured. The association between obstructive CAD and ASGES was evaluated using Cochran-Armitage trend test and area under the receiver-operating characteristics curve (AUC) analyses. Results: The rate of obstructive CAD among patients with a positive MPI was 35% (88/249). There was a net redistribution of risk based on ASGES testing in 52% (49/88) of these patients. The rate of obstructive CAD was 11% (7/63), 37% (39/106), and 53% (42/80) in the low, mid-range, and high score groups respectively (p<0.001). AUC for the ASGES use with a positive MPI was 0.704. Conclusion: The ASGES test, when used in patients after positive MPI, improved the diagnostic accuracy in the assessment of obstructive CAD. The use of this precision medicine test may help minimize unnecessary referral of low-intermediate risk patients as well as improve diagnostic yield among patients with abnormal MPI findings scheduled to undergo invasive coronary angiography.

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