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Incremental prognostic value of spect over CCTA.

Awad Javaid1, Ahmed Ibrahim Ahmed2, Yushui Han2

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Combining coronary CT angiography (CCTA) with SPECT myocardial perfusion imaging (MPI) improves risk prediction for patients with suspected coronary artery disease (CAD). This integrated approach offers better prognostic insights than CCTA alone.

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Area of Science:

  • Cardiovascular Imaging
  • Diagnostic Cardiology
  • Nuclear Cardiology

Background:

  • Coronary computed tomographic angiography (CCTA) and Single Photon Emission Computed Tomography (SPECT) myocardial perfusion imaging (MPI) are key for assessing coronary artery disease (CAD).
  • CCTA provides anatomical detail, while SPECT MPI offers functional insights into myocardial perfusion.
  • Integrating both modalities may enhance diagnostic and prognostic capabilities in patients with suspected CAD.

Purpose of the Study:

  • To evaluate the incremental prognostic value of SPECT MPI's physiologic assessment when added to CCTA in patients with suspected CAD.
  • To determine if functional data from SPECT MPI improves risk prediction beyond anatomical information from CCTA.

Main Methods:

  • A cohort of 956 patients with suspected CAD who underwent both CCTA and SPECT MPI within 180 days was analyzed.
  • Patients were followed for major adverse cardiovascular events (MACE), including death, myocardial infarction, and revascularization.
  • Multivariable Cox regression models assessed the predictive performance of CCTA alone versus CCTA combined with SPECT findings (perfusion and left ventricular function).

Main Results:

  • Obstructive stenosis was identified in 14% of patients; scar, ischemia, and reduced ejection fraction (<40%) were present in 17%, 14%, and 9%, respectively.
  • Adding SPECT-derived perfusion and left ventricular function to a CCTA-based model significantly improved risk prediction (Harrell's C = 0.73, p=0.037).
  • The combined assessment led to significant risk reclassification on a continuous scale (P < 0.001).

Conclusions:

  • Combined assessment of perfusion burden and left ventricular function from SPECT MPI adds incremental prognostic value.
  • This integrated approach surpasses the predictive capability of CCTA-based anatomic assessment alone in patients with suspected CAD.
  • This study highlights the benefit of combining anatomic and functional imaging for comprehensive CAD risk stratification.