The value of regional and global CACS combined with SPECT MPI in detecting obstructive CAD: a retrospective real-world comparative study

Qi Jiang; Bao Liu; Le Yang; Yufeng Wang; Wenji Yu; Feifei Zhang; Yunmei Shi; Yuetao Wang

doi:10.1186/s12872-023-03051-y

The value of regional and global CACS combined with SPECT MPI in detecting obstructive CAD: a retrospective real-world comparative study

BMC Cardiovasc Disord. 2023 Jan 11;23(1):12. doi: 10.1186/s12872-023-03051-y.

Authors

Qi Jiang^#^{1

2}, Bao Liu^#¹, Le Yang¹, Yufeng Wang¹, Wenji Yu¹, Feifei Zhang¹, Yunmei Shi¹, Yuetao Wang^{3

4}

Affiliations

¹ Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China.
² Yangzhou University, Yangzhou, Jiangsu Province, China.
³ Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China. yuetao-w@163.com.
⁴ Yangzhou University, Yangzhou, Jiangsu Province, China. yuetao-w@163.com.

^# Contributed equally.

Abstract

Objective: Previous studies have shown that global coronary artery calcium score (CACS) can improve single photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) to detect obstructive coronary artery disease (CAD). Whether regional CACS can improve SPECT MPI to detect obstructive CAD remains unclear. The aim of this study was to verify whether regional CACS has additional diagnostic value for obstructive CAD in suspected patients, compared to SPECT MPI and global CACS.

Methods: The study included 321 suspected CAD patients who underwent one-stop rest-stress SPECT MPI and low-dose computed tomography (CT) scan. All patients underwent coronary angiography within one month after examination. MPI images were visually analyzed by 2 experienced nuclear cardiologists. The regional CACS of left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), right coronary artery (RCA) and global CACS were calculated. Obstructive CAD was defined as ≥ 70% narrowing of the inner diameter of the LAD, LCX, RCA or their main branches and ≥ 50% narrowing of the left main coronary artery (LM).

Results: Among the 321 patients, 86 (26.8%, 86/321) had obstructive CAD. With the increased in global and regional CACS, there was an increasing trend of patients with obstructive CAD (P for trend < 0.001). Regional CACS had a better diagnostic performance in RCA territories (AUC 0.856, P < 0.001) compared with LAD, LCX territories (AUC 0.690, 0.674, respectively). The AUC of combined regional CACS and MPI was significantly higher than that of MPI alone (0.735 vs. 0.600, P < 0.001). However, based on MPI, the AUC of combined regional CACS was not significantly higher than that of global CACS (0.735 vs. 0.732, P = 0.898). The sensitivity and specificity of regional CACS combined with MPI for detecting obstructive CAD were 64.0% and 72.8%, respectively.

Conclusions: Regional CACS was effective in detecting obstructive CAD in RCA territory. Based on SPECT MPI, regional CACS improved the detection of obstructive CAD, but was not superior to global CACS.

Keywords: Coronary artery calcium score; Coronary artery disease; Myocardial perfusion imaging; SPECT.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Coronary Angiography / methods
Coronary Artery Disease* / diagnosis
Humans
Myocardial Perfusion Imaging* / methods
Retrospective Studies
Tomography, Emission-Computed, Single-Photon / methods
Tomography, X-Ray Computed / methods

Abstract

Publication types

MeSH terms

Grants and funding