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Benz DC, Giannopoulos AA. Fractional flow reserve as the standard of reference: All that glistens is not gold. J Nucl Cardiol 2020; 27:1314-1316. [PMID: 31175624 DOI: 10.1007/s12350-019-01771-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Dominik C Benz
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
- Cardiology Department, University Hospital Zurich, Zurich, Switzerland.
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Mushtaq S, Conte E, Pontone G, Baggiano A, Annoni A, Formenti A, Mancini ME, Guglielmo M, Muscogiuri G, Tanzilli A, Nicoli F, Bartorelli AL, Pepi M, Andreini D. State-of-the-art-myocardial perfusion stress testing: Static CT perfusion. J Cardiovasc Comput Tomogr 2020; 14:294-302. [DOI: 10.1016/j.jcct.2019.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/27/2019] [Accepted: 09/07/2019] [Indexed: 01/06/2023]
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Boscolo Berto M, Benz DC, Gräni C. Noninvasive Assessment of Coronary Artery Disease - Anatomical versus Functional Imaging and the Marginal Role of Exercise Electrocardiograms. PRAXIS 2020; 109:1141-1149. [PMID: 33108995 DOI: 10.1024/1661-8157/a003531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the industrialized countries. Assessment of symptomatic patients with suspected obstructive CAD is a common reason for a clinical visit. Noninvasive anatomical and functional imaging are established tools to rule-in and rule-out CAD, to assess the severity of disease and to determine the potential risk of future cardiovascular events. In this review, we discuss the updated Guidelines from the European Society of Cardiology on Chronic Coronary Syndromes and explore the different imaging modalities used in current clinical practice for the noninvasive assessment of CAD. The pros and cons of each method, especially comparing anatomical and functional testing, are presented. Furthermore we we address the practical clinical aspects in the selection of the optimal noninvasive tests according to clinical need.
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Affiliation(s)
| | - Dominik C Benz
- Department of Nuclear Medicine and Department of Cardiology, University Hospital Zurich
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern
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Benz DC, Gräni C, Ferro P, Neumeier L, Messerli M, Possner M, Clerc OF, Gebhard C, Gaemperli O, Pazhenkottil AP, Kaufmann PA, Buechel RR. Corrected coronary opacification decrease from coronary computed tomography angiography: Validation with quantitative 13N-ammonia positron emission tomography. J Nucl Cardiol 2019; 26:561-568. [PMID: 28685251 DOI: 10.1007/s12350-017-0980-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND To assess the functional relevance of a coronary artery stenosis, corrected coronary opacification (CCO) decrease derived from coronary computed tomography angiography (CCTA) has been proposed. The present study aims at validating CCO decrease with quantitative 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI). METHODS AND RESULTS This retrospective study consists of 39 patients who underwent hybrid CCTA/PET-MPI. From CCTA, attenuation in the coronary lumen was measured before and after a stenosis and corrected to the aorta to calculate CCO and its decrease. Relative flow reserve (RFR) was calculated by dividing the stress myocardial blood flow (MBF) of a vessel territory subtended by a stenotic coronary by the stress MBF of the reference territories without stenoses. RFR was abnormal in 11 vessel territories (27%). CCO decrease yielded a sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for prediction of an abnormal RFR of 73%, 70%, 88%, 47%, and 70%, respectively. CONCLUSIONS CCTA-derived CCO decrease has moderate diagnostic accuracy to predict an abnormal RFR in PET-MPI. However, its high negative predictive value to rule out functional relevance of a given lesion may confer clinical implications in the diagnostic work-up of patients with a coronary stenosis.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Paola Ferro
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Luis Neumeier
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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5
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Impact of cardiac hybrid imaging-guided patient management on clinical long-term outcome. Int J Cardiol 2018; 261:218-222. [DOI: 10.1016/j.ijcard.2018.01.118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/22/2017] [Accepted: 01/26/2018] [Indexed: 12/29/2022]
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6
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Andreini D, Conte E, Mushtaq S. Cardiac hybrid imaging for the management of patients with known or suspected coronary artery disease. Int J Cardiol 2018; 261:236-238. [DOI: 10.1016/j.ijcard.2018.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/06/2018] [Indexed: 11/26/2022]
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7
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Benz DC, Fuchs TA. Breathless or breathtaking: Respiratory motion correction. J Nucl Cardiol 2018; 25:429-432. [PMID: 27435279 DOI: 10.1007/s12350-016-0590-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 07/05/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, University Hospital Zurich, Ramistr 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, University Hospital Zurich, Ramistr 100, 8091, Zurich, Switzerland.
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Nudi F, Biondi-Zoccai G. Cadmium-zinc-telluride myocardial perfusion imaging: The dream of a single test gets nearer. J Nucl Cardiol 2018; 25:550-554. [PMID: 28251505 DOI: 10.1007/s12350-017-0833-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Francesco Nudi
- Service of Hybrid Cardio Imaging, Madonna della Fiducia Clinic, Via Giuseppe Mantellini 3, 00179, Rome, Italy.
- Ostia Radiologica, Rome, Italy.
- ETISAN, Rome, Italy.
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
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Benz DC, Mikulicic F, Gräni C, Grossmann M, Giannopoulos AA, Messerli M, Gebhard C, Gaemperli O, Buechel RR, Kaufmann PA, Pazhenkottil AP. Diagnostic accuracy of coronary opacification derived from coronary computed tomography angiography to detect ischemia: first validation versus single-photon emission computed tomography. EJNMMI Res 2017; 7:92. [PMID: 29178006 PMCID: PMC5701907 DOI: 10.1186/s13550-017-0342-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/12/2017] [Indexed: 11/24/2022] Open
Abstract
Background Estimation of functional relevance of a coronary stenosis by fractional flow reserve (FFR) from coronary computed tomography angiography (CCTA) has recently provided encouraging results. Due to its limited availability, the corrected contrast opacification (CCO) decrease and the transluminal attenuation gradient (TAG) were suggested as less complex alternatives. The aim of the present study was to assess the accuracy of CCO decrease and TAG to predict ischemia as assessed by single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Results This retrospective study included 72 patients who underwent hybrid CCTA/SPECT MPI with at least one coronary artery stenosis. Of 127 vessels with a coronary stenosis in CCTA, 38 (30%) were causing ischemia in its subtending myocardium. The area under the curve (AUC) for CCO decrease to predict ischemia was 0.707 with sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 74, 64, 85, 47, and 67%, respectively. For TAG, the AUC was 0.469. Conclusions CCTA-derived CCO decrease but not TAG predicts ischemia in SPECT MPI. The negative predictive value of CCO decrease of 85% may confer clinical implications in the diagnostic work-up of patients with a coronary stenosis.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Marvin Grossmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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Gimelli A, Achenbach S, Buechel RR, Edvardsen T, Francone M, Gaemperli O, Hacker M, Hyafil F, Kaufmann PA, Lancellotti P, Nieman K, Pontone G, Pugliese F, Verberne HJ, Gutberlet M, Bax JJ, Neglia D, Gerber B, Donal E, Flachskampf F, Haugaa K, Delgado V, Knuuti J, Knaapen P, Maurovich-Horvat P, Schroeder S. Strategies for radiation dose reduction in nuclear cardiology and cardiac computed tomography imaging: a report from the European Association of Cardiovascular Imaging (EACVI), the Cardiovascular Committee of European Association of Nuclear Medicine (EANM), and the European Society of Cardiovascular Radiology (ESCR). Eur Heart J 2017; 39:286-296. [DOI: 10.1093/eurheartj/ehx582] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/26/2017] [Indexed: 12/23/2022] Open
Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana/CNR Gabriele Monasterio, Via Moruzzi 1, 56124 Pisa, Italy
| | - Stephan Achenbach
- Department of Internal Medicine 2 (Cardiology), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thor Edvardsen
- Oslo University Hospital, Department of Cardiology, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Fabien Hyafil
- Department of Nuclear Medicine, Bichat University Hospital, Assistance Publique—Hôpitaux de Paris, Inserm 1148, DHU FIRE, University Paris 7 Diderot, Paris, France
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Patrizio Lancellotti
- Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University, School of Medicine, Stanford, CA, USA
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Yonsei University Health System, Seoul, South Korea
| | - Francesca Pugliese
- NIHR Barts BRC, Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Jeroen J Bax
- Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Danilo Neglia
- Fondazione Toscana/CNR Gabriele Monasterio, Via Moruzzi 1, 56124 Pisa, Italy
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Benz DC, Mikulicic F, Gräni C, Moret D, Possner M, Clerc OF, Studer Bruengger AA, Gaemperli O, Buechel RR, Pazhenkottil AP, Kaufmann PA. Long-term outcome prediction by functional parameters derived from coronary computed tomography angiography. Int J Cardiol 2017; 243:533-537. [PMID: 28592383 DOI: 10.1016/j.ijcard.2017.05.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/28/2017] [Accepted: 05/17/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Estimation of hemodynamic relevance of a coronary stenosis from coronary computed angiography (CCTA) has raised substantial interest. Recently, the corrected coronary opacification (CCO) decrease and the transluminal attenuation gradient (TAG) have been suggested as faster alternatives to the FFRCT. The aim of the study was to evaluate whether the diagnostic accuracy of CCO decrease and TAG translates into an added prognostic value in patients evaluated for coronary artery disease (CAD). METHODS This retrospective study consists of 162 consecutive patients referred for evaluation of known or suspected CAD by CCTA. CCO decrease was defined as difference of mean luminal coronary attenuation normalized to aorta attenuation proximal-distal of a stenosis. To calculate TAG, mean attenuation was measured at 5-mm intervals from the ostium to a distal segment with a minimal cross-sectional area of 2.0mm2. Death, myocardial infarction, unstable angina requiring hospitalization, and coronary revascularization were defined as major adverse cardiac events (MACE). Multivariate analysis included covariates age, sex, ≥3 cardiovascular risk factors and stenosis severity. RESULTS Follow-up was completed in 154 patients, CAD was found in 72. During median follow-up of 6.1years (interquartile range, 5.8-6.9years), 55 patients experienced a MACE. Among CAD patients, the presence of an abnormal CCO decrease (p<0.05) but not TAG (p=0.894) was associated with a worse MACE-free survival. In multivariate analysis, CCO decrease was an independent predictor of MACE (HR, 2.27; 95% CI, 1.14-4.52; p=0.02) while TAG was not predictive (p=0.895). CONCLUSION In CAD patients, CCO decrease adds long-term prognostic value over clinical characteristics and stenosis severity while TAG does not.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Dominic Moret
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Annina A Studer Bruengger
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
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Lüscher TF. From conventional to molecular imaging: delineating mechanisms, diagnosis, and outcomes. Eur Heart J 2017; 38:377-380. [DOI: 10.1093/eurheartj/ehx010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nudi F, Lotrionte M, Biasucci LM, Peruzzi M, Marullo AG, Frati G, Valenti V, Giordano A, Biondi-Zoccai G. Comparative safety and effectiveness of coronary computed tomography: Systematic review and meta-analysis including 11 randomized controlled trials and 19,957 patients. Int J Cardiol 2016; 222:352-358. [PMID: 27500763 DOI: 10.1016/j.ijcard.2016.07.269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/26/2016] [Accepted: 07/30/2016] [Indexed: 02/08/2023]
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Lüscher TF. Imaging as a basis of clinical decision-making in congenital and coronary disease and heart failure. Eur Heart J 2016; 37:1171-3. [DOI: 10.1093/eurheartj/ehw141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Liga R, Vontobel J, Rovai D, Marinelli M, Caselli C, Pietila M, Teresinska A, Aguadé-Bruix S, Pizzi MN, Todiere G, Gimelli A, Chiappino D, Marraccini P, Schroeder S, Drosch T, Poddighe R, Casolo G, Anagnostopoulos C, Pugliese F, Rouzet F, Le Guludec D, Cappelli F, Valente S, Gensini GF, Zawaideh C, Capitanio S, Sambuceti G, Marsico F, Filardi PP, Fernández-Golfín C, Rincón LM, Graner FP, de Graaf MA, Stehli J, Reyes E, Nkomo S, Mäki M, Lorenzoni V, Turchetti G, Carpeggiani C, Puzzuoli S, Mangione M, Marcheschi P, Giannessi D, Nekolla S, Lombardi M, Sicari R, Scholte AJHA, Zamorano JL, Underwood SR, Knuuti J, Kaufmann PA, Neglia D, Gaemperli O. Multicentre multi-device hybrid imaging study of coronary artery disease: results from the EValuation of INtegrated Cardiac Imaging for the Detection and Characterization of Ischaemic Heart Disease (EVINCI) hybrid imaging population. Eur Heart J Cardiovasc Imaging 2016; 17:951-60. [PMID: 26992419 DOI: 10.1093/ehjci/jew038] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/14/2016] [Indexed: 12/18/2022] Open
Abstract
AIMS Hybrid imaging provides a non-invasive assessment of coronary anatomy and myocardial perfusion. We sought to evaluate the added clinical value of hybrid imaging in a multi-centre multi-vendor setting. METHODS AND RESULTS Fourteen centres enrolled 252 patients with stable angina and intermediate (20-90%) pre-test likelihood of coronary artery disease (CAD) who underwent myocardial perfusion scintigraphy (MPS), CT coronary angiography (CTCA), and quantitative coronary angiography (QCA) with fractional flow reserve (FFR). Hybrid MPS/CTCA images were obtained by 3D image fusion. Blinded core-lab analyses were performed for CTCA, MPS, QCA and hybrid datasets. Hemodynamically significant CAD was ruled-in non-invasively in the presence of a matched finding (myocardial perfusion defect co-localized with stenosed coronary artery) and ruled-out with normal findings (both CTCA and MPS normal). Overall prevalence of significant CAD on QCA (>70% stenosis or 30-70% with FFR≤0.80) was 37%. Of 1004 pathological myocardial segments on MPS, 246 (25%) were reclassified from their standard coronary distribution to another territory by hybrid imaging. In this respect, in 45/252 (18%) patients, hybrid imaging reassigned an entire perfusion defect to another coronary territory, changing the final diagnosis in 42% of the cases. Hybrid imaging allowed non-invasive CAD rule-out in 41%, and rule-in in 24% of patients, with a negative and positive predictive value of 88% and 87%, respectively. CONCLUSION In patients at intermediate risk of CAD, hybrid imaging allows non-invasive co-localization of myocardial perfusion defects and subtending coronary arteries, impacting clinical decision-making in almost one every five subjects.
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Affiliation(s)
- Riccardo Liga
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Jan Vontobel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | | | | | | | - Mikko Pietila
- Heart Center and Turku PET Center, University of Turku, Turku University Hospital, Turku, Finland
| | - Anna Teresinska
- Department of Nuclear Medicine, Institute of Cardiology, Warsaw, Poland
| | - Santiago Aguadé-Bruix
- Department of Nuclear Medicine, University Hospital Val d'Hebron, Institut Catala de la Salut, Barcelona, Spain
| | - Maria Nazarena Pizzi
- Department of Nuclear Medicine, University Hospital Val d'Hebron, Institut Catala de la Salut, Barcelona, Spain
| | - Giancarlo Todiere
- Cardiothoracic Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Alessia Gimelli
- Imaging Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Dante Chiappino
- Imaging Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | | | - Tanja Drosch
- Department of Cardiology, Alb-Fils-Kliniken, Göppingen, Germany
| | - Rosa Poddighe
- Emergency Department, Cardiology, Ospedale della Versilia, Lido di Camaiore, Italy
| | - Giancarlo Casolo
- Emergency Department, Cardiology, Ospedale della Versilia, Lido di Camaiore, Italy
| | - Constantinos Anagnostopoulos
- Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece Centre for Advanced Cardiovascular Imaging, National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | - Francesca Pugliese
- Centre for Advanced Cardiovascular Imaging, National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | - Francois Rouzet
- Department of Nuclear Medicine, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France
| | - Dominique Le Guludec
- Department of Nuclear Medicine, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France
| | - Francesco Cappelli
- Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Serafina Valente
- Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Gian Franco Gensini
- Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy Don Carlo Gnocchi Foundation, IRCCS, Florence, Italy
| | - Camilla Zawaideh
- Department of Health Science and Internal Medicine, IRCCS Hospital San Martino, National Institute for Cancer Research and University of Genoa, Genoa, Italy
| | - Selene Capitanio
- Department of Health Science and Internal Medicine, IRCCS Hospital San Martino, National Institute for Cancer Research and University of Genoa, Genoa, Italy
| | - Gianmario Sambuceti
- Department of Health Science and Internal Medicine, IRCCS Hospital San Martino, National Institute for Cancer Research and University of Genoa, Genoa, Italy
| | - Fabio Marsico
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | | | - Luis M Rincón
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Frank P Graner
- Department of Nuclear Medicine, Klinikum Rechts der Isar der Technischen Universität München, Muenchen, Germany
| | - Michiel A de Graaf
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Julia Stehli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Eliana Reyes
- Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Sandy Nkomo
- Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Maija Mäki
- Heart Center and Turku PET Center, University of Turku, Turku University Hospital, Turku, Finland
| | | | | | | | - Stefano Puzzuoli
- Technology Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Maurizio Mangione
- Technology Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Paolo Marcheschi
- Technology Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | - Stephan Nekolla
- Department of Nuclear Medicine, Klinikum Rechts der Isar der Technischen Universität München, Muenchen, Germany
| | - Massimo Lombardi
- Imaging Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Rosa Sicari
- Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - José L Zamorano
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - S Richard Underwood
- Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Juhani Knuuti
- Heart Center and Turku PET Center, University of Turku, Turku University Hospital, Turku, Finland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Danilo Neglia
- Institute of Clinical Physiology, CNR, Pisa, Italy Cardiothoracic Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
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Lüscher TF. Imaging and outcomes in cardiac, valvular, and peripheral arterial disease. Eur Heart J 2016; 37:657-9. [DOI: 10.1093/eurheartj/ehw049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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