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Comparative Effectiveness of CT-Derived Atherosclerotic Plaque Metrics for Predicting Myocardial Ischemia.
JACC Cardiovasc Imaging. 2019 07; 12(7 Pt 2):1367-1376.JC

Abstract

OBJECTIVES

This study sought to investigate the performance of various cardiac computed tomography (CT)-derived atherosclerotic plaque metrics for predicting provocable myocardial ischemia.

BACKGROUND

The association of coronary arterial diameter stenosis with myocardial ischemia is only modest, but cardiac CT provides several other, readily available atherosclerosis metrics, which may have incremental value.

METHODS

The study analyzed 873 nonstented coronary arteries and their myocardial perfusion territories in 356 patients (mean 62 years of age) enrolled in the CORE320 (Coronary Artery Evaluation using 320-row Multidetector Computed Tomography Angiography and Myocardial Perfusion) study. Myocardial perfusion defects in static CT perfusion imaging were graded at rest and after adenosine in 13 myocardial segments using a 4-point scale. The summed difference score was calculated by subtracting the summed rest score from the summed stress score. Reversible ischemia was defined as summed difference score ≥1. In a sensitivity analysis, results were also provided using single-photon emission computed tomography (SPECT) as the reference standard. Vessel based predictor variables included maximum percent diameter stenosis, lesion length, coronary calcium score, maximum cross-sectional calcium arc, percent atheroma volume (PAV), low-attenuation atheroma volume, positive (external) vascular remodeling, and subjective impression of "vulnerable plaque." The study used logistic regression models to assess the association of plaque metrics with myocardial ischemia.

RESULTS

In univariate analysis, all plaque metrics were associated with reversible ischemia. In the adjusted logistic model, only maximum percent diameter stenosis (1.26; 95% confidence interval: 1.15 to 1.38) remained an independent predictor. With SPECT as outcome variable, PAV and "vulnerable" plaque remained predictive after adjustment. In vessels with intermediate stenosis (40% to 70%), no single metric had clinically meaningful incremental value.

CONCLUSIONS

Various plaque metrics obtained by cardiac CT predict provocable myocardial ischemia by CT perfusion imaging through their association with maximum percent stenosis, while none had significant incremental value. With SPECT as reference standard, PAV and "vulnerable plaque" remained predictors of ischemia after adjustment but the predictive value added to stenosis assessment alone was small.

Authors+Show Affiliations

Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.Universidade Federal do Paraná, Curitiba, Brazil; Heart Institute (InCor), University of São Paulo, São Paulo, Brazil.MedImmune, Gaithersburg, Maryland.Department of Radiology, Leiden University/Medical Imaging Systems, Leiden, the Netherlands.MedImmune, Gaithersburg, Maryland.Division of Cardiology, St. Luke's International Hospital, Tokyo, Japan.Department of Radiology, Leiden University/Medical Imaging Systems, Leiden, the Netherlands.Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.Heart Institute (InCor), University of São Paulo, São Paulo, Brazil.Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. Electronic address: azadeh1@jhmi.edu.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30031705

Citation

Bakhshi, Hooman, et al. "Comparative Effectiveness of CT-Derived Atherosclerotic Plaque Metrics for Predicting Myocardial Ischemia." JACC. Cardiovascular Imaging, vol. 12, no. 7 Pt 2, 2019, pp. 1367-1376.
Bakhshi H, Meyghani Z, Kishi S, et al. Comparative Effectiveness of CT-Derived Atherosclerotic Plaque Metrics for Predicting Myocardial Ischemia. JACC Cardiovasc Imaging. 2019;12(7 Pt 2):1367-1376.
Bakhshi, H., Meyghani, Z., Kishi, S., Magalhães, T. A., Vavere, A., Kitslaar, P. H., George, R. T., Niinuma, H., Reiber, J. H. C., Betoko, A., Matheson, M., Rochitte, C. E., Di Carli, M. F., Cox, C., Lima, J. A. C., & Arbab-Zadeh, A. (2019). Comparative Effectiveness of CT-Derived Atherosclerotic Plaque Metrics for Predicting Myocardial Ischemia. JACC. Cardiovascular Imaging, 12(7 Pt 2), 1367-1376. https://doi.org/10.1016/j.jcmg.2018.05.019
Bakhshi H, et al. Comparative Effectiveness of CT-Derived Atherosclerotic Plaque Metrics for Predicting Myocardial Ischemia. JACC Cardiovasc Imaging. 2019;12(7 Pt 2):1367-1376. PubMed PMID: 30031705.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative Effectiveness of CT-Derived Atherosclerotic Plaque Metrics for Predicting Myocardial Ischemia. AU - Bakhshi,Hooman, AU - Meyghani,Zahra, AU - Kishi,Satoru, AU - Magalhães,Tiago A, AU - Vavere,Andrea, AU - Kitslaar,Pieter H, AU - George,Richard T, AU - Niinuma,Hiroyuki, AU - Reiber,Johan H C, AU - Betoko,Aisha, AU - Matheson,Matthew, AU - Rochitte,Carlos E, AU - Di Carli,Marcelo F, AU - Cox,Christopher, AU - Lima,João A C, AU - Arbab-Zadeh,Armin, Y1 - 2018/07/18/ PY - 2018/01/22/received PY - 2018/05/16/revised PY - 2018/05/24/accepted PY - 2018/7/23/pubmed PY - 2020/3/19/medline PY - 2018/7/23/entrez KW - CT perfusion KW - CT plaque characterization KW - cardiac CT KW - diameter stenosis KW - plaque burden SP - 1367 EP - 1376 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 12 IS - 7 Pt 2 N2 - OBJECTIVES: This study sought to investigate the performance of various cardiac computed tomography (CT)-derived atherosclerotic plaque metrics for predicting provocable myocardial ischemia. BACKGROUND: The association of coronary arterial diameter stenosis with myocardial ischemia is only modest, but cardiac CT provides several other, readily available atherosclerosis metrics, which may have incremental value. METHODS: The study analyzed 873 nonstented coronary arteries and their myocardial perfusion territories in 356 patients (mean 62 years of age) enrolled in the CORE320 (Coronary Artery Evaluation using 320-row Multidetector Computed Tomography Angiography and Myocardial Perfusion) study. Myocardial perfusion defects in static CT perfusion imaging were graded at rest and after adenosine in 13 myocardial segments using a 4-point scale. The summed difference score was calculated by subtracting the summed rest score from the summed stress score. Reversible ischemia was defined as summed difference score ≥1. In a sensitivity analysis, results were also provided using single-photon emission computed tomography (SPECT) as the reference standard. Vessel based predictor variables included maximum percent diameter stenosis, lesion length, coronary calcium score, maximum cross-sectional calcium arc, percent atheroma volume (PAV), low-attenuation atheroma volume, positive (external) vascular remodeling, and subjective impression of "vulnerable plaque." The study used logistic regression models to assess the association of plaque metrics with myocardial ischemia. RESULTS: In univariate analysis, all plaque metrics were associated with reversible ischemia. In the adjusted logistic model, only maximum percent diameter stenosis (1.26; 95% confidence interval: 1.15 to 1.38) remained an independent predictor. With SPECT as outcome variable, PAV and "vulnerable" plaque remained predictive after adjustment. In vessels with intermediate stenosis (40% to 70%), no single metric had clinically meaningful incremental value. CONCLUSIONS: Various plaque metrics obtained by cardiac CT predict provocable myocardial ischemia by CT perfusion imaging through their association with maximum percent stenosis, while none had significant incremental value. With SPECT as reference standard, PAV and "vulnerable plaque" remained predictors of ischemia after adjustment but the predictive value added to stenosis assessment alone was small. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/30031705/Comparative_Effectiveness_of_CT_Derived_Atherosclerotic_Plaque_Metrics_for_Predicting_Myocardial_Ischemia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(18)30468-6 DB - PRIME DP - Unbound Medicine ER -