Normalized Subendocardial Myocardial Attenuation on Coronary Computed Tomography Angiography Predicts Postoperative Adverse Cardiovascular Events: Coronary CTA VISION Substudy

Walpot J 1 , Massalha S 1 , Jayasinghe P 1 , Sadaf M 1 , Clarkin O 1 , Godkin L 1 Show all authors , Sharma A 1 , Ratnayake I 1 , Godkin K 1 , Jia K 1 , Hossain A 2 , Crean AM 1 , Chan M 3 , Butler C 4 , Tandon V 5 , Nagele P 6 , Woodard PK 7 , Mrkobrada M 8 , Szczeklik W 9 , Aziz YFA 10 , Biccard B 11 , Devereaux PJ 5 , Sheth T 5 , Chow BJW 1

Affiliations 

  • 1 Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  • 2 Cardiovascular Research Methods Centre (A.H.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  • 3 Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (M.C.)
  • 4 Department of Medicine (Cardiology), Alberta Heart Institute and University of Alberta, Edmonton, Alberta, Canada (C.B.)
  • 5 Population Health Research Institute and Department of Medicine, David Braley Cardiac, Vascular, and Stroke Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (V.T., P.J.D., T.S.)
  • 6 Department of Anesthesiology (P.N.), Washington University School of Medicine, St. Louis, MO
  • 7 Mallinckrodt Institute of Radiology (P.K.W.), Washington University School of Medicine, St. Louis, MO
  • 8 Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada (M.M.)
  • 9 Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland (W.S.)
  • 10 Department of Biomedical Imaging, University Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (Y.F.A.A.)
  • 11 Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa (B.B.)
Circ Cardiovasc Imaging, 2022 01;15(1):e012654.
PMID: 35041449 DOI: 10.1161/CIRCIMAGING.121.012654

Abstract

BACKGROUND: Abnormalities in computed tomography myocardial perfusion has been associated with coronary artery disease and major adverse cardiovascular events (MACE). We sought to investigate if subendocardial attenuation using coronary computed tomography angiography predicts MACE 30 days postelective noncardiac surgery.

METHODS: Using a 17-segment model, coronary computed tomography angiography images were analyzed for subendocardial and transmural attenuation and the corresponding blood pool. The segment with the lowest subendocardial attenuation and transmural attenuation were normalized to the segment with the highest subendocardial and transmural attenuation, respectively (SUBnormalized, and TRANSnormalized, respectively). We evaluated the independent and incremental value of myocardial attenuation to predict the composite of cardiovascular death or nonfatal myocardial infarction.

RESULTS: Of a total of 995 coronary CTA VISION (Coronary Computed Tomographic Angiography and Vascular Events in Noncardiac Surgery Patients Cohort Evaluation Study) patients, 735 had available images and complete data for these analyses. Among these patients, 60 had MACE. Based on Revised Cardiovascular Risk Index, 257, 302, 138, and 38 patients had scores of 0, 1, 2, and ≥3, respectively. On coronary computed tomography angiography, 75 patients had normal coronary arteries, 297 patients had nonobstructive coronary artery disease, 264 patients had obstructive disease, and 99 patients had extensive obstructive coronary artery disease. SUBnormalized was an independent and incremental predictor of events in the model that included Revised Cardiovascular Risk Index and coronary artery disease severity. Compared with patients in the highest tertile of SUBnormalized, patients in the second and first tertiles had an increased hazards ratio for events (2.23 [95% CI, 1.091-4.551] and 2.36 [95% CI, 1.16-4.81], respectively). TRANSnormalized, as a continuous variable, was also found to be a predictor of MACE (P=0.027).

CONCLUSIONS: Our study demonstrates that SUBnormalized and TRANSnormalized are independent and incremental predictors of MACE 30 days after elective noncardiac surgery. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01635309.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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