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Coronary artery calcium score and N‐terminal pro‐B‐type natriuretic peptide as potential gatekeepers for myocardial perfusion imaging
Author(s) -
Haarmark Christian,
Andersen Kim Francis,
Madsen Claus,
Zerahn Bo
Publication year - 2017
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12363
Subject(s) - medicine , cardiology , perfusion , natriuretic peptide , calcium , myocardial perfusion imaging , coronary artery disease , artery , coronary artery calcium , heart failure
Summary 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 ‐pro BNP as potential gatekeepers for MPI . Patients with intermediate risk of CHD referred for standard MPI were included. CAC score and NT ‐pro BNP 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 ‐pro BNP 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 ‐pro BNP >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 ‐pro BNP could be used to identify a group of patients where MPI could be averted with a high degree of diagnostic safety.