Bär, Sarah; Maaniitty, Teemu; Nabeta, Takeru; Bax, Jeroen J; Earls, James P; Min, James K; Saraste, Antti; Knuuti, Juhani (2024). Prognostic value of a novel artificial intelligence-based coronary CTA-derived ischemia algorithm among patients with normal or abnormal myocardial perfusion. Journal of cardiovascular computed tomography, 18(4), pp. 366-374. Elsevier 10.1016/j.jcct.2024.04.001
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BACKGROUND
Among patients with obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CTA), downstream positron emission tomography (PET) perfusion imaging can be performed to assess the presence of myocardial ischemia. A novel artificial-intelligence-guided quantitative computed tomography ischemia algorithm (AI-QCTischemia) aims to predict ischemia directly from coronary CTA images. We aimed to study the prognostic value of AI-QCTischemia among patients with obstructive CAD on coronary CTA and normal or abnormal downstream PET perfusion.
METHODS
AI-QCTischemia was calculated by blinded analysts among patients from the retrospective coronary CTA cohort at Turku University Hospital, Finland, with obstructive CAD on initial visual reading (diameter stenosis ≥50%) being referred for downstream 15O-H2O-PET adenosine stress perfusion imaging. All coronary arteries with their side branches were assessed by AI-QCTischemia. Absolute stress myocardial blood flow ≤2.3 ml/g/min in ≥2 adjacent segments was considered abnormal. The primary endpoint was death, myocardial infarction, or unstable angina pectoris. The median follow-up was 6.2 [IQR 4.4-8.3] years.
RESULTS
662 of 768 (86%) patients had conclusive AI-QCTischemia result. In patients with normal 15O-H2O-PET perfusion, an abnormal AI-QCTischemia result (n = 147/331) vs. normal AI-QCTischemia result (n = 184/331) was associated with a significantly higher crude and adjusted rates of the primary endpoint (adjusted HR 2.47, 95% CI 1.17-5.21, p = 0.018). This did not pertain to patients with abnormal 15O-H2O-PET perfusion (abnormal AI-QCTischemia result (n = 269/331) vs. normal AI-QCTischemia result (n = 62/331); adjusted HR 1.09, 95% CI 0.58-2.02, p = 0.794) (p-interaction = 0.039).
CONCLUSION
Among patients with obstructive CAD on coronary CTA referred for downstream 15O-H2O-PET perfusion imaging, AI-QCTischemia showed incremental prognostic value among patients with preserved perfusion by 15O-H2O-PET imaging, but not among those with reduced perfusion.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology |
UniBE Contributor: |
Bär, Sarah |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1876-861X |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
01 May 2024 08:06 |
Last Modified: |
03 Jul 2024 00:14 |
Publisher DOI: |
10.1016/j.jcct.2024.04.001 |
PubMed ID: |
38664074 |
Uncontrolled Keywords: |
Artificial intelligence Coronary computed tomography angiography Ischemia Positron emission tomography Prognosis |
BORIS DOI: |
10.48350/196275 |
URI: |
https://boris.unibe.ch/id/eprint/196275 |
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