Coronary artery calcium score and N-terminal pro-B-type natriuretic peptide as potential gatekeepers for myocardial perfusion imaging.
Clin Physiol Funct Imaging
; 37(6): 710-716, 2017 Nov.
Article
em En
| MEDLINE
| ID: mdl-27005324
ABSTRACT
Myocardial perfusion imaging (MPI) holds an important place as non-invasive risk assessment in patients with intermediate risk of coronary heart disease (CHD). However, as much as 60-70% of MPI scans are normal. This study evaluates the role of coronary artery calcium scoring (CAC score) and NT-proBNP as potential gatekeepers for MPI. Patients with intermediate risk of CHD referred for standard MPI were included. CAC score and NT-proBNP were both assessed at the day of the stress study. Sensitivity, specificity and NPV for prediction of abnormal MPI scans were calculated for CAC, NT-proBNP and the combination hereof. A total of 190 patients were included (mean age 61 ± 12 years, 55% female) of whom 24% had known CHD. In all 30% of the scans were abnormal. CAC score achieved the highest AUC regardless of whether patients with known CHD were included or not [AUC 0·75 95% CI (0·66-0·84) and AUC 0·79 (0·68-0·91)]. As a singular variable, CAC score was the most potent predictor with a sensitivity of 85%, specificity of 39% and NPV 88%. The combination of CAC score<10 and NT-proBNP>26 reached a sensitivity of 98% and NPV 94%, where 8% of scans tentatively could be avoided. In patients referred for MPI with intermediate risk for CHD, a combination of CAC score and NT-proBNP could be used to identify a group of patients where MPI could be averted with a high degree of diagnostic safety.
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MEDLINE
Assunto principal:
Fragmentos de Peptídeos
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Doença da Artéria Coronariana
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Angiografia Coronária
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Circulação Coronária
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Vasos Coronários
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Peptídeo Natriurético Encefálico
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Imagem de Perfusão do Miocárdio
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Calcificação Vascular
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Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único
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Angiografia por Tomografia Computadorizada
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article