背景:即使在无症状患者中,在冠状动脉钙化或瓣膜钙化患者的心肌灌注扫描中,缺血与冠状动脉钙化或瓣膜钙化高度相关.没有冠状动脉钙化的患者心血管事件发生率极低。没有心血管钙化,包括冠状动脉,瓣膜,胸主动脉是心肌缺血的强阴性预测因子。在怀疑有缺血的个体中,有胸部计算机断层扫描成像,心血管钙化的评估(冠状动脉,阀门,和胸主动脉)是指导进一步诊断成像的宝贵工具。我们假设完全不存在心血管钙化对心肌灌注成像(例如单光子发射计算机断层扫描(SPECT)或正电子发射断层扫描(PET))中的缺陷具有很高的阴性预测值。
方法:从2017年3月1日至2017年9月30日进行的SPECT/PETCT衰减校正的非对比计算机断层扫描,由一名对患者病史不知情的心脏病专家和放射科医生进行回顾性审查,以确定没有心血管钙化。对医疗记录进行了审查,以包括患者的人口统计学和病史。共分析132例患者。
结果:在132例无钙化的患者中,7例患者有小的心肌灌注缺陷提示缺血或梗塞,但没有一个被认为是重大缺陷。在这七个病人中,其中6人接受医疗管理,1人来自外部机构,没有随访数据.7例患者中有2例接受了随访的侵入性血管造影或冠状动脉CTA,但未显示明显的动脉粥样硬化性冠状动脉疾病。
结论:在当天的验证性核应激测试中,完全没有心血管钙化表明显著灌注缺陷的阴性预测值为100%。怀疑有缺血但没有心血管钙化的患者可以安全地进行医学管理,而无需进一步测试缺血。
BACKGROUND: Even in asymptomatic patients, there is a high association of ischemia on myocardial perfusion scans in those with coronary artery calcification or valvular calcifications. Patients without coronary artery calcifications have exceeding-low rates of cardiovascular events. The absence of cardiovascular calcification, including coronary artery, valvular, and thoracic aorta is a strong negative predictor of myocardial ischemia. In individuals with suspected ischemia who had chest computed tomography imaging, evaluation for cardiovascular calcification (coronary artery, valves, and thoracic aorta) is an invaluable tool to guide management for further diagnostic imaging. We hypothesize that the complete absence of cardiovascular calcification has a high negative predictive value for defects in myocardial perfusion imaging such as single-photon emission computed tomography (SPECT) or positron emission tomography (PET).
METHODS: Non-contrast computed tomography performed for SPECT/PET CT attenuation correction from March 1, 2017, to September 30, 2017, were retrospectively reviewed for the absence of cardiovascular calcification by a cardiologist and radiologist who were blinded to patients\' medical history. Medical records were reviewed to include patient demographics and medical history. A total of 132 patients were analyzed.
RESULTS: Of the 132 patients without calcifications, seven patients had small myocardial perfusion defects suggestive of ischemia or infarct, but none were considered significant defects. Of these seven patients, six were managed medically and one was from an outside institution with no follow-up data. Two of the seven patients had follow-up invasive angiography or coronary CTA that did not show significant atherosclerotic coronary artery disease.
CONCLUSIONS: A complete absence of cardiovascular calcification indicates a 100% negative predictive value for a significant perfusion defect on same-day confirmatory nuclear stress testing. Patients with suspected ischemia but absent cardiovascular calcifications can be safely managed medically without further testing for ischemia.