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Long-term prognostic value of computed tomography-based attenuation correction on thallium-201 myocardial perfusion
Jei-Yie Huang1,2, Ruoh-Fang Yen1, Chun-Kai Huang2,3
1Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Insights
Attenuation correction (AC) in myocardial perfusion imaging (MPI) shows similar prognostic value to non-AC (NAC) for predicting cardiovascular events. Both AC and NAC MPI are significant predictors for mortality and cardiovascular events in patients with coronary artery disease.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Myocardial perfusion imaging (MPI) is a key tool for diagnosing and predicting outcomes in coronary artery disease (CAD).
- The prognostic value of attenuation correction (AC) in MPI remains controversial, with limited investigation.
- Computed tomography (CT)-based AC in thallium-201 (Tl-201) MPI requires further evaluation for its prognostic utility.
Purpose of the Study:
- To assess the prognostic value of CT-based attenuation correction (AC) in thallium-201 (Tl-201) myocardial perfusion imaging (MPI).
- To compare the predictive capabilities of AC MPI versus non-AC (NAC) MPI for cardiovascular outcomes.
Main Methods:
- 108 patients undergoing Tl-201 MPI and coronary angiography were retrospectively analyzed.
- Patient data and outcomes were collected through medical records and telephone contact.
- Prognostic value was determined using Kaplan-Meier analysis and Cox proportional hazards models.
Main Results:
- Over a mean follow-up of 7.7 years, 27 deaths and 41 cardiovascular-related re-admissions occurred.
- Both AC and NAC MPI showed significant differences in Kaplan-Meier curves for all-cause mortality.
- Multivariable analysis indicated similar independent predictive values for SSS and SRS in both AC and NAC MPI for mortality and composite events.
- Subgroup analysis suggested AC MPI may offer better risk stratification in obese patients.
Conclusions:
- CT-based AC and NAC MPI demonstrated comparable prognostic value.
- Both AC and NAC MPI were significant predictors for the composite endpoint of mortality and cardiovascular events.
- AC MPI may enhance risk stratification in specific patient groups, such as those with obesity.
Background:
Myocardial perfusion imaging (MPI) is a well-established diagnostic tool to evaluate coronary artery disease (CAD) and also an effective prognostic tool for patients with CAD. However, few studies investigated the prognostic value of attenuation correction (AC) in MPI, and the results were controversial.
Objectives:
To investigate the prognostic value of computed tomography (CT)-based AC thallium-201 (Tl-201) MPI.
Methods:
A total of 108 consecutive patients who underwent Tl-201 MPI and received coronary angiography within 90 days were included. Medical records were reviewed and missing information was completed after telephone contact. The prognostic value was evaluated by Kaplan-Meier analysis, univariable and multivariable Cox proportional hazards model.
Results:
After a mean follow-up of 7.72 ± 3.72 years, 27 patients had died, 41 had been readmitted for cardiovascular (CV)-related events and 44 had reached the composite of death plus CV-related re-admission. Kaplan-Meier curves for all-cause mortality for SSS with a cutoff value of 13 for AC and 16 for non-AC (NAC) images showed a significant difference between the two curves for both AC and NAC images (p = 0.011 for AC and p = 0.021 for NAC). In the multivariable model, SSS and SRS showed similar independent predictive values in predicting all-cause mortality and composite of all-cause mortality plus CV-related re-admission, in both AC and NAC images. Subgroup analysis implicated that AC MPI possibly provided better risk stratification in obese patients.
Conclusion:
CT-based AC and NAC MPI showed similar value and were the only significant predictors for the composite of mortality and CV events.
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