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Coronary artery calcium score and N-terminal pro-B-type natriuretic peptide as potential gatekeepers for myocardial

Christian Haarmark1,2, Kim Francis Andersen3, Claus Madsen1

  • 1Department of Clinical Physiology & Nuclear Medicine, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Herlev, Denmark.

Clinical Physiology and Functional Imaging
|March 24, 2016
PubMed

Insights

Coronary artery calcium scoring and NT-proBNP can help avoid unnecessary myocardial perfusion imaging in intermediate-risk patients. This combination identifies patients who can safely skip MPI, improving diagnostic efficiency.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Preventive Cardiology

Background:

  • Myocardial perfusion imaging (MPI) is crucial for non-invasive risk assessment in intermediate-risk coronary heart disease (CHD) patients.
  • A significant proportion (60-70%) of MPI scans yield normal results, indicating potential overuse.
  • Identifying gatekeepers for MPI can optimize resource allocation and patient management.

Purpose of the Study:

  • To evaluate coronary artery calcium (CAC) scoring and NT-proBNP as gatekeepers for MPI.
  • To determine their efficacy in predicting abnormal MPI scans in intermediate-risk CHD patients.
  • To assess the combined utility of CAC score and NT-proBNP for potentially averting MPI.

Main Methods:

  • Prospective evaluation of 190 intermediate-risk CHD patients referred for MPI.
  • Assessment of CAC score and NT-proBNP on the day of the stress study.
  • Calculation of sensitivity, specificity, and negative predictive value (NPV) for predicting abnormal MPI scans.

Main Results:

  • CAC score demonstrated the highest Area Under the Curve (AUC) for predicting abnormal MPI (AUC 0.75-0.79).
  • CAC score alone showed high sensitivity (85%) and NPV (88%).
  • The combination of CAC score < 10 and NT-proBNP > 26 achieved 98% sensitivity and 94% NPV, potentially avoiding 8% of scans.

Conclusions:

  • CAC score and NT-proBNP can effectively identify patients who may not require MPI.
  • Combining CAC score and NT-proBNP offers high diagnostic safety for ruling out abnormal MPI findings.
  • This approach can help avert MPI in a select group of intermediate-risk CHD patients, enhancing diagnostic safety and efficiency.

Keywords:
SPECT99mTc-sestamibiCoronary heart diseasecoronary artery calciummyocardial perfusion imaging

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