Functional-anatomic integration by CCTA and exercise SPECT in adults with anomalous aortic origin of a coronary
Stefano Figliozzi1, Francesco Amata1, Antonio De Luca2
1IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy.
Insights
Anomalous aortic origin of a coronary artery (AAOCA) linked to high-risk anatomy can cause ischemia and arrhythmias. Combining coronary CT angiography (CCTA) and stress SPECT improves risk assessment in these patients.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Anomalous aortic origin of a coronary artery (AAOCA) is linked to exertional ischemia, arrhythmias, and adverse outcomes.
- The connection between high-risk anatomical features and functional consequences in AAOCA is not fully understood.
- Coronary computed tomography angiography (CCTA) and exercise-stress myocardial perfusion scintigraphy (SPECT) offer complementary assessments of anatomy, ischemia, and arrhythmias.
Purpose of the Study:
- To investigate the relationship between high-risk anatomical features identified by CCTA and functional consequences like ischemia and arrhythmias assessed by exercise-stress SPECT in adults with AAOCA.
- To evaluate the diagnostic and prognostic performance of CCTA, SPECT, and combined imaging models for risk stratification in AAOCA patients.
Main Methods:
- Retrospective analysis of consecutive adult patients with AAOCA who underwent both CCTA and exercise-stress ^99mTc-SPECT between 2010 and 2025.
- Inducible ischemia defined by a summed difference score (SDS) ≥4 on SPECT.
- Assessment of a composite endpoint including death, myocardial infarction, angina, ventricular arrhythmias, or coronary revascularization.
- Evaluation of discriminative performance using ROC analysis for ECG, CCTA, SPECT, and combined models.
Main Results:
- Thirty-five patients (mean age 51±15 years, 89% men) were included.
- High-risk CCTA features were present in 60%, and inducible ischemia on SPECT in 51%.
- An interarterial course was significantly associated with SPECT positivity (67% vs. 12%, p=0.007).
- Ventricular arrhythmias during exercise were more common in SPECT-positive patients (50% vs. 13%, p=0.03).
- The combined CCTA+SPECT model demonstrated the highest discrimination (AUC 0.76) during a median 59-month follow-up.
Conclusions:
- Integrating CCTA and exercise-SPECT effectively links high-risk AAOCA anatomy to functional and arrhythmic manifestations.
- Combined imaging may enhance risk stratification for adults diagnosed with anomalous aortic origin of a coronary artery.
Background:
Anomalous aortic origin of a coronary artery (AAOCA) may be associated with exertional ischemia, ventricular arrhythmias, and adverse outcomes. The relationship between high-risk anatomic features and functional consequences remains incompletely defined. Coronary computed tomography angiography (CCTA) and exercise-stress myocardial perfusion scintigraphy (SPECT) present as complementary modalities for integrated assessment of anatomy, ischemia, and arrhythmias.
Methods:
We retrospectively studied consecutive adults with AAOCA undergoing CCTA and exercise-stress ^99mTc-SPECT between 2010 and 2025 at two centers. Inducible ischemia was defined as a summed difference score (SDS) ≥4. A composite endpoint (death, myocardial infarction, angina requiring evaluation, ventricular arrhythmias, or coronary revascularization) was assessed during follow-up. Discriminative performance of ECG, CCTA, SPECT, and combined imaging models was evaluated using ROC analysis.
Results:
Thirty-five patients (mean age 51 ± 15 years; 89% men) were included. At least one high-risk CCTA feature was present in 60% of cases, and inducible ischemia occurred in 51%. An interarterial course was significantly associated with SPECT positivity (67% vs. 12%, p = 0.007). Ventricular arrhythmias during exercise were more frequent in SPECT-positive patients (50% vs. 13%, p = 0.03). During a median follow-up of 59 months, the combined CCTA+SPECT model showed the highest discrimination (AUC 0.76).
Conclusions:
Integrating CCTA with exercise-SPECT links high-risk anatomy to functional and arrhythmic manifestations and may improve risk stratification in adults with AAOCA.
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