Ahmed Ibrahim Ahmed1, Yushui Han1, Mahmoud Al Rifai2, Talal Alnabelsi1, Faisal Nabi1, Su Min Chang1, Myra Cocker3, Chris Schwemmer4, Juan C Ramirez-Giraldo5, Neal S Kleiman1, William A Zoghbi1, John J Mahmarian1, Mouaz H Al-Mallah6. 1. Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA. 2. Baylor College of Medicine, Houston, Texas, USA. 3. Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA; Computed Tomography-Research Collaborations, Siemens Healthineers, Malvern, Pennsylvania, USA. 4. Computed Tomography-Research and Development, Siemens Healthcare GmbH, Forchheim, Germany. 5. Computed Tomography-Research Collaborations, Siemens Healthineers, Malvern, Pennsylvania, USA. 6. Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA. Electronic address: mal-mallah@houstonmethodist.org.
Abstract
OBJECTIVES: The aim of this study was to compare the incremental prognostic value of coronary computed tomography (CT) angiography (CCTA)-derived machine learning fractional flow reserve CT (ML-FFRct) versus that of ischemia detected on single-photon emission-computed tomography (SPECT) myocardial perfusion imaging (MPI) on incident cardiovascular outcomes. BACKGROUND: SPECT MPI and ML-FFRct are noninvasive tools that can assess the hemodynamic significance of coronary atherosclerotic disease. METHODS: We studied a retrospective cohort of consecutive patients who underwent clinically indicated CCTA and SPECT MPI. ML-FFRct was computed using a ML prototype. The primary outcome was all-cause mortality and nonfatal myocardial infarction (D/MI), and the secondary outcome was D/MI and unplanned revascularization, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) occurring more than 90 days postimaging. Multiple nested multivariate cox regression was used to model a scenario wherein an initial anatomical assessment was followed by a functional assessment. RESULTS: A total of 471 patients (mean age: 64 ± 13 year; 53% males) were included. Comorbidities were prevalent (78% hypertension, 66% diabetes, 81% dyslipidemia). ML-FFRct was <0.8 in at least 1 proximal/midsegment was present in 41.6% of patients, and ischemia on MPI was present in 13.8%. After a median follow-up of 18 months, 7% of patients (n = 33) experienced D/MI. On multivariate Cox proportional analysis, the presence of ischemia on MPI but not ML-FFRct significantly predicted D/MI (HR: 2.3; 95% CI: 1.0-5.0; P = 0.047; or HR: 0.7; 95% CI: 0.3-1.4; P = 0.306 respectively) when added to CCTA obstructive stenosis. Furthermore, the model with SPECT ischemia had higher global chi-square result and significantly improved reclassification. Results were similar using the secondary outcome and on several sensitivity analyses. CONCLUSIONS: In a high-risk patient cohort, SPECT MPI but not ML-FFRct adds independent and incremental prognostic information to CCTA-based anatomical assessment and clinical risk factors in predicting incident outcomes.
OBJECTIVES: The aim of this study was to compare the incremental prognostic value of coronary computed tomography (CT) angiography (CCTA)-derived machine learning fractional flow reserve CT (ML-FFRct) versus that of ischemia detected on single-photon emission-computed tomography (SPECT) myocardial perfusion imaging (MPI) on incident cardiovascular outcomes. BACKGROUND: SPECT MPI and ML-FFRct are noninvasive tools that can assess the hemodynamic significance of coronary atherosclerotic disease. METHODS: We studied a retrospective cohort of consecutive patients who underwent clinically indicated CCTA and SPECT MPI. ML-FFRct was computed using a ML prototype. The primary outcome was all-cause mortality and nonfatal myocardial infarction (D/MI), and the secondary outcome was D/MI and unplanned revascularization, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) occurring more than 90 days postimaging. Multiple nested multivariate cox regression was used to model a scenario wherein an initial anatomical assessment was followed by a functional assessment. RESULTS: A total of 471 patients (mean age: 64 ± 13 year; 53% males) were included. Comorbidities were prevalent (78% hypertension, 66% diabetes, 81% dyslipidemia). ML-FFRct was <0.8 in at least 1 proximal/midsegment was present in 41.6% of patients, and ischemia on MPI was present in 13.8%. After a median follow-up of 18 months, 7% of patients (n = 33) experienced D/MI. On multivariate Cox proportional analysis, the presence of ischemia on MPI but not ML-FFRct significantly predicted D/MI (HR: 2.3; 95% CI: 1.0-5.0; P = 0.047; or HR: 0.7; 95% CI: 0.3-1.4; P = 0.306 respectively) when added to CCTA obstructive stenosis. Furthermore, the model with SPECT ischemia had higher global chi-square result and significantly improved reclassification. Results were similar using the secondary outcome and on several sensitivity analyses. CONCLUSIONS: In a high-risk patient cohort, SPECT MPI but not ML-FFRct adds independent and incremental prognostic information to CCTA-based anatomical assessment and clinical risk factors in predicting incident outcomes.
Authors: Randall C Thompson; Mouaz H Al-Mallah; Rob S B Beanlands; Dennis A Calnon; Sharmila Dorbala; Lawrence M Phillips; Donna M Polk; Prem Soman Journal: J Nucl Cardiol Date: 2021-11-15 Impact factor: 5.952
Authors: Andrew E Arai; Raymond Y Kwong; Michael Salerno; John P Greenwood; Chiara Bucciarelli-Ducci Journal: J Cardiovasc Magn Reson Date: 2022-01-03 Impact factor: 6.903
Authors: Yushui Han; Ahmed Ibrahim Ahmed; Chris Schwemmer; Myra Cocker; Talal S Alnabelsi; Jean Michel Saad; Juan C Ramirez Giraldo; Mouaz H Al-Mallah Journal: Open Heart Date: 2022-03
Authors: Mahmoud Al Rifai; Ahmed Ibrahim Ahmed; Yushui Han; Jean Michel Saad; Talal Alnabelsi; Faisal Nabi; Su Min Chang; Myra Cocker; Chris Schwemmer; Juan C Ramirez-Giraldo; William A Zoghbi; John J Mahmarian; Mouaz H Al-Mallah Journal: Sci Rep Date: 2022-08-16 Impact factor: 4.996