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- Title
Importance of plaque volume and composition for the prediction of myocardial ischaemia using sequential coronary computed tomography angiography/positron emission tomography imaging.
- Authors
Wang, Xu; Hoogen, Inge J van den; Butcher, Steele C; Kuneman, Jurrien H; Graaf, Michiel A de; Kamperidis, Vasileios; Boukes, Mark; Maaniitty, Teemu; Schultz, Jussi; Rosendael, Alexander R van; Saraste, Antti; Knuuti, Juhani; Bax, Jeroen J
- Abstract
Aims Coronary atherosclerosis with a large necrotic core has been postulated to reduce the vasodilatory capacity of vascular tissue. In the present analysis, we explored whether total plaque volume and necrotic core volume on coronary computed tomography angiography (CCTA) are independently associated with myocardial ischaemia on positron emission tomography (PET). Methods and results From a registry of symptomatic patients with suspected coronary artery disease and clinically indicated CCTA with sequential [15O]H2O PET myocardial perfusion imaging, we quantitatively measured diameter stenosis, total and compositional plaque volumes on CCTA. Primary endpoint was myocardial ischaemia on PET, defined as an absolute stress myocardial blood flow ≤2.4 mL/g/min in ≥1 segment. Multivariable prediction models for myocardial ischaemia were consecutively created using logistic regression analysis (stenosis model: diameter stenosis ≥50%; plaque volume model: +total plaque volume; plaque composition model: +necrotic core volume). A total of 493 patients (mean age 63 ± 8 years, 54% men) underwent sequential CCTA/PET imaging. In 153 (31%) patients, myocardial ischaemia was detected on PET. Diameter stenosis ≥50% (P < 0.001) and necrotic core volume (P = 0.029) were independently associated with myocardial ischaemia, while total plaque volume showed borderline significance (P = 0.052). The plaque composition model (χ2 = 169) provided incremental value for the prediction of ischaemia when compared with the stenosis model (χ2 = 138, P < 0.001) and plaque volume model (χ2 = 164, P = 0.021). Conclusion The volume of necrotic core on CCTA independently and incrementally predicts myocardial ischaemia on PET, beyond diameter stenosis alone.
- Subjects
BLOOD vessels; MYOCARDIAL ischemia; POSITRON emission tomography computed tomography; QUANTITATIVE research; ATHEROSCLEROSIS; CORONARY artery disease; DESCRIPTIVE statistics; CHI-squared test; RESEARCH funding; COMPUTED tomography; PREDICTION models; LOGISTIC regression analysis
- Publication
European Heart Journal - Cardiovascular Imaging, 2023, Vol 24, Issue 6, p776
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jeac130