Single-photon emission computed tomography myocardial ischemia detection in high-risk asymptomatic patients: correlation with coronary calcium score and high-sensitivity C-reactive protein

• Published in: Indian journal of nuclear medicine Vol. 34; no. 2; pp. 99 - 106
• Main Authors: Mitevska, Irena, Srbinovska, Elizabeta, Stojanovska, Lily, Antova, Emilija, Apostolopoulos, Vasso, Bosevski, Marijan
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.04.2019; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow
• Subjects: Angina pectoris; Atherosclerosis; C-reactive protein; Calcium; Cardiology; Cardiovascular disease; CAT scans; Cholesterol; Computation; Computed tomography; Confidence intervals; Coronary artery disease; Coronary heart disease; Coronary vessels; Disease prevention; Health risk assessment; Heart attacks; Hormone replacement therapy; Hypertension; Inflammation; Ischemia; Laboratories; Low density lipoprotein; Medical imaging; Myocardial ischemia; Nuclear medicine; Original; Patients; Photon emission; Proteins; Regression analysis; Risk analysis; Sensitivity analysis; Single photon emission computed tomography; Statistical analysis; Studies; Tomography; Type 2 diabetes; Values; Coronary Artery Calcium Score; high-sensitivity C-reactive protein; single-photon emission computed tomography myocardial imaging
• ISSN: 0972-3919; 0974-0244
• DOI: 10.4103/ijnm.IJNM_152_18

Background: The association between myocardial ischemia in high-risk patients with coronary calcium score (CCS) and high-sensitivity C-reactive protein (hs-CRP) is not well established. Aims: We evaluated the correlation between hs-CRP, CCS, and myocardial ischemia in asymptomatic high-risk patients without known coronary artery disease (CAD). Materials and Methods: We prospectively assessed 68 asymptomatic high-risk outpatients without known CAD. One-day rest-stress Tc-99m single-photon emission computed tomography (SPECT) myocardial perfusion imaging and multislice computed tomography were performed. Multivariate regression analysis was performed for the assessment of predictors of myocardial ischemia. Standard risk factors and hs-CRP values were analyzed. Results: CCS >0 Agatston score was observed in 26 patients (46.4%). Seven patients had CCS between 10 and 99 AU, 8 patients between 100 and 400 AU, and 11 patients had CCS >400 AU. Mild ischemia was noted in 11 patients, moderate ischemia in 10 patients, and severe ischemia in 6 patients. Hs-CRP was >1 mg/L in 39 patients, of whom 8 patients had CCS >0, 13 patients had normal SPECT results, 6 patients had mild ischemia, and 12 patients had moderate and severe ischemia. Multivariate regression analysis showed independent predictors for increased CCS: low-density lipoprotein cholesterol (odds ratio [OR]: 2.891; P = 0.001); age >70 years (OR: 2.568; P = 0.001); and smoking (OR: 1.931; P = 0.001). We found hs-CRP to be an independent predictor of myocardial ischemia (OR: 4.145; 95% confidence interval: 1.398-7.471, P = 0.001). Conclusion: hs-CRP was an independent predictor of myocardial ischemia. hs-CRP might improve the selection of high-risk asymptomatic patients for myocardial SPECT imaging.