Single-Photon Emission Computed Tomography Myocardial Ischemia Detection in High-Risk Asymptomatic Patients:
Irena Mitevska1, Elizabeta Srbinovska1, Lily Stojanovska2
1Department of Nuclear Cardiology, University Cardiology Clinic, Skopje, Macedonia.
Insights
High-sensitivity C-reactive protein (hs-CRP) independently predicts myocardial ischemia in high-risk patients. hs-CRP may help identify asymptomatic individuals needing further cardiac evaluation.
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Imaging
Background:
- The relationship between coronary calcium score (CCS), high-sensitivity C-reactive protein (hs-CRP), and myocardial ischemia in high-risk individuals is not fully understood.
- Coronary artery disease (CAD) risk stratification often relies on traditional risk factors, but novel biomarkers may enhance prediction.
Purpose of the Study:
- To investigate the correlation between hs-CRP, CCS, and myocardial ischemia in asymptomatic high-risk patients without known CAD.
- To identify predictors of myocardial ischemia and elevated CCS in this population.
Main Methods:
- Prospective assessment of 68 asymptomatic high-risk outpatients without known CAD.
- Utilized Tc-99m SPECT myocardial perfusion imaging and multislice computed tomography.
- Multivariate regression analysis to determine independent predictors of myocardial ischemia and CCS, including hs-CRP and standard risk factors.
Main Results:
- Coronary calcium score >0 was present in 46.4% of patients.
- Mild, moderate, and severe ischemia were observed in 11, 10, and 6 patients, respectively.
- hs-CRP was an independent predictor of myocardial ischemia (OR: 4.145, P=0.001), while LDL cholesterol, age >70, and smoking predicted increased CCS.
Conclusions:
- hs-CRP is an independent predictor of myocardial ischemia in asymptomatic high-risk patients.
- hs-CRP may aid in selecting patients for further cardiac imaging, such as myocardial SPECT.
Background:
The association between myocardial ischemia in high-risk patients with coronary calcium score (CCS) and high-sensitivity C-reactive protein (hs-CRP) is not well established.
Aims:
We evaluated the correlation between hs-CRP, CCS, and myocardial ischemia in asymptomatic high-risk patients without known coronary artery disease (CAD).
Materials And Methods:
We prospectively assessed 68 asymptomatic high-risk outpatients without known CAD. One-day rest-stress Tc-99m single-photon emission computed tomography (SPECT) myocardial perfusion imaging and multislice computed tomography were performed. Multivariate regression analysis was performed for the assessment of predictors of myocardial ischemia. Standard risk factors and hs-CRP values were analyzed.
Results:
CCS >0 Agatston score was observed in 26 patients (46.4%). Seven patients had CCS between 10 and 99 AU, 8 patients between 100 and 400 AU, and 11 patients had CCS >400 AU. Mild ischemia was noted in 11 patients, moderate ischemia in 10 patients, and severe ischemia in 6 patients. Hs-CRP was >1 mg/L in 39 patients, of whom 8 patients had CCS >0, 13 patients had normal SPECT results, 6 patients had mild ischemia, and 12 patients had moderate and severe ischemia. Multivariate regression analysis showed independent predictors for increased CCS: low-density lipoprotein cholesterol (odds ratio [OR]: 2.891; P = 0.001); age >70 years (OR: 2.568; P = 0.001); and smoking (OR: 1.931; P = 0.001). We found hs-CRP to be an independent predictor of myocardial ischemia (OR: 4.145; 95% confidence interval: 1.398-7.471, P = 0.001).
Conclusion:
hs-CRP was an independent predictor of myocardial ischemia. hs-CRP might improve the selection of high-risk asymptomatic patients for myocardial SPECT imaging.
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