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Published on: February 16, 2016
Normalized Subendocardial Myocardial Attenuation on Coronary Computed Tomography Angiography Predicts Postoperative
Jeroen Walpot1, Samia Massalha1, Pranisha Jayasinghe1
1Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Insights
Subendocardial and transmural attenuation on coronary computed tomography angiography predict major adverse cardiovascular events (MACE) within 30 days after noncardiac surgery. These myocardial perfusion metrics offer valuable prognostic information for surgical risk stratification.
Area of Science:
- Cardiology
- Radiology
- Cardiovascular Imaging
Background:
- Abnormalities in computed tomography myocardial perfusion are linked to coronary artery disease and major adverse cardiovascular events (MACE).
- Subendocardial attenuation on coronary computed tomography angiography (CCTA) may predict MACE post-elective noncardiac surgery.
Purpose of the Study:
- To investigate if subendocardial attenuation, assessed via CCTA, predicts MACE within 30 days after elective noncardiac surgery.
- To evaluate the independent and incremental value of myocardial attenuation in predicting cardiovascular death or nonfatal myocardial infarction.
Main Methods:
- Analysis of CCTA images using a 17-segment model to quantify subendocardial and transmural attenuation.
- Normalization of attenuation values (SUBnormalized, TRANSnormalized) and assessment of their predictive value for MACE.
- Inclusion of Revised Cardiovascular Risk Index and coronary artery disease severity in the predictive model.
Main Results:
- In a cohort of 735 patients, 60 experienced MACE.
- SUBnormalized was an independent and incremental predictor of MACE, with higher attenuation linked to lower event risk.
- TRANSnormalized also predicted MACE (P=0.027).
Conclusions:
- SUBnormalized and TRANSnormalized are independent and incremental predictors of MACE within 30 days post-elective noncardiac surgery.
- These CCTA-derived myocardial attenuation metrics enhance risk stratification for patients undergoing noncardiac surgery.
Background:
Abnormalities in computed tomography myocardial perfusion has been associated with coronary artery disease and major adverse cardiovascular events (MACE). We sought to investigate if subendocardial attenuation using coronary computed tomography angiography predicts MACE 30 days postelective noncardiac surgery.
Methods:
Using a 17-segment model, coronary computed tomography angiography images were analyzed for subendocardial and transmural attenuation and the corresponding blood pool. The segment with the lowest subendocardial attenuation and transmural attenuation were normalized to the segment with the highest subendocardial and transmural attenuation, respectively (SUBnormalized, and TRANSnormalized, respectively). We evaluated the independent and incremental value of myocardial attenuation to predict the composite of cardiovascular death or nonfatal myocardial infarction.
Results:
Of a total of 995 coronary CTA VISION (Coronary Computed Tomographic Angiography and Vascular Events in Noncardiac Surgery Patients Cohort Evaluation Study) patients, 735 had available images and complete data for these analyses. Among these patients, 60 had MACE. Based on Revised Cardiovascular Risk Index, 257, 302, 138, and 38 patients had scores of 0, 1, 2, and ≥3, respectively. On coronary computed tomography angiography, 75 patients had normal coronary arteries, 297 patients had nonobstructive coronary artery disease, 264 patients had obstructive disease, and 99 patients had extensive obstructive coronary artery disease. SUBnormalized was an independent and incremental predictor of events in the model that included Revised Cardiovascular Risk Index and coronary artery disease severity. Compared with patients in the highest tertile of SUBnormalized, patients in the second and first tertiles had an increased hazards ratio for events (2.23 [95% CI, 1.091-4.551] and 2.36 [95% CI, 1.16-4.81], respectively). TRANSnormalized, as a continuous variable, was also found to be a predictor of MACE (P=0.027).
Conclusions:
Our study demonstrates that SUBnormalized and TRANSnormalized are independent and incremental predictors of MACE 30 days after elective noncardiac surgery. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01635309.
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