![Quantification of Atherosclerotic Plaque Activity and Vascular Inflammation using [18-F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography FDG-PET/CT](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F3777.jpg&w=3840&q=50)
Added prognostic value of plaque burden to computed tomography angiography and myocardial perfusion imaging
Ahmed Ibrahim Ahmed1, Yushui Han1, Mahmoud Al Rifai2
1Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA.
Insights
Plaque burden measured by coronary artery disease (CAD) imaging adds significant prognostic value beyond traditional assessments. This finding improves prediction of cardiovascular events in high-risk patients.
Area of Science:
- Cardiology
- Medical Imaging
- Prognostics
Background:
- Coronary artery disease (CAD) burden assessed by CCTA predicts cardiovascular events.
- High-risk patients often undergo both CCTA and SPECT imaging.
- The added prognostic value of plaque burden over these assessments is not fully understood.
Purpose of the Study:
- To compare the prognostic value of plaque burden against CCTA and SPECT.
- To evaluate risk prediction in patients with suspected CAD and high cardiovascular risk factors.
Main Methods:
- Included 956 patients undergoing CCTA and SPECT for suspected CAD.
- Assessed stenosis severity and segment involvement score (SIS) from CCTA.
- Determined ischemia from SPECT and followed for major adverse cardiovascular events (MACE).
Main Results:
- SIS significantly predicted outcomes independently.
- Plaque burden (SIS) improved risk discrimination when added to CCTA stenosis models (Harrel's C 0.74).
- Plaque burden (SIS) improved risk discrimination when added to SPECT ischemia models (Harrel's C 0.76).
Conclusions:
- Plaque burden provides incremental prognostic value in suspected CAD.
- This adds predictive power beyond established CCTA and SPECT measures.
- Useful for predicting cardiovascular outcomes in high-risk populations.
Background And Aims:
Cardiac computed tomographic angiography (CCTA) - derived measures of coronary artery disease (CAD) burden have been shown to independently predict incident cardiovascular events. We aimed to compare the added prognostic value of plaque burden to CCTA anatomic assessment and single photon emission computed tomography (SPECT) physiologic assessment in a cohort with high prevalence of risk factors undergoing both tests.
Methods:
Consecutive patients who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected CAD were included. Stenosis severity and segment involvement score (SIS - number of segments with plaque irrespective of stenosis) were determined from CCTA, and presence of ischemia was determined from SPECT. Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and percutaneous coronary intervention or coronary artery bypass grafting 90-days after imaging test.) RESULTS: A total of 956 patients were included (mean age 61.1 ± 14.2 years, 54% men, 89% hypertension, 81% diabetes, 84% dyslipidemia). Obstructive stenosis (left main ≥50%, all other coronary segments ≥70%) and ischemia were observed in a similar number of patients (14%). In multivariable Cox regression models, SIS significantly predicted outcomes and improved risk discrimination in models with CCTA obstructive stenosis (HR 1.15, p ≤ 0.001; Harrel's C 0.74, p = 0.008) and SPECT ischemia (HR 1.14, p < 0.001; Harrel's C 0.76, p = 0.019).
Conclusions:
Our results suggest that in patients with suspected CAD and a high prevalence of risk-factors, plaque burden adds incremental prognostic value over established CCTA and SPECT measures to predict incident cardiovascular outcomes.
More Related Videos
09:36A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
Published on: August 12, 2025
08:13In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Imaging Studies for Cardiovascular System V: CT
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...