Predictive value of multislice computed tomography variables of atherosclerosis for ischemia on stress-rest single-photon emission computed tomography.
BACKGROUND
previous studies have shown that the presence of stenosis alone on multislice computed tomography (MSCT) has a limited positive predictive value for the presence of ischemia on myocardial perfusion imaging (MPI). The purpose of this study was to assess which variables of atherosclerosis on MSCT angiography are related to ischemia on MPI.


RESULTS
both MSCT and MPI were performed in 514 patients. On MSCT, the calcium score, degree of stenosis (≥ 50% and ≥ 70% stenosis), and plaque extent and location were determined. Plaque composition was classified as noncalcified, mixed, or calcified. Ischemia was defined as a summed difference score (≥ 2 on a per-patient basis. Ischemia was observed in 137 patients (27%). On a per-patient basis, multivariate analysis showed that the degree of stenosis (presence of (≥ 70% stenosis, odds ratio=3.5), plaque extent and composition (mixed plaques (≥3, odds ratio=1.7; calcified plaques ≥ 3, odds ratio=2.0), and location (atherosclerotic disease in the left main coronary artery and/or proximal left anterior descending coronary artery, odds ratio=1.6) were independent predictors for ischemia on MPI. In addition, MSCT variables of atherosclerosis, such as plaque extent, composition, and location, had significant incremental value for the prediction of ischemia over the presence of ≥70% stenosis.


CONCLUSIONS
in addition to the degree of stenosis, MSCT variables of atherosclerosis describing plaque extent, composition, and location are predictive of the presence of ischemia on MPI.
van Velzen
Joëlla E
JE
Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands.
Schuijf
Joanne D
JD
van Werkhoven
Jacob M
JM
Herzog
Bernhard A
BA
Pazhenkottil
Aju P
AP
Boersma
Eric
E
de Graaf
Fleur R
FR
Scholte
Arthur J
AJ
Kroft
Lucia J
LJ
de Roos
Albert
A
Stokkel
Marcel P
MP
Jukema
J Wouter
JW
Kaufmann
Philipp A
PA
van der Wall
Ernst E
EE
Bax
Jeroen J
JJ
D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012146:Rest; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D036542:Tomography, Spiral Computed / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol