Riccardo Liga1, Jan Vontobel2, Daniele Rovai3, Martina Marinelli3, Chiara Caselli3, Mikko Pietila4, Anna Teresinska5, Santiago Aguadé-Bruix6, Maria Nazarena Pizzi6, Giancarlo Todiere7, Alessia Gimelli8, Dante Chiappino8, Paolo Marraccini3, Stephen Schroeder9, Tanja Drosch9, Rosa Poddighe10, Giancarlo Casolo10, Constantinos Anagnostopoulos11, Francesca Pugliese12, Francois Rouzet13, Dominique Le Guludec13, Francesco Cappelli14, Serafina Valente14, Gian Franco Gensini15, Camilla Zawaideh16, Selene Capitanio16, Gianmario Sambuceti16, Fabio Marsico17, Pasquale Perrone Filardi17, Covadonga Fernández-Golfín18, Luis M Rincón18, Frank P Graner19, Michiel A de Graaf20, Julia Stehli2, Eliana Reyes21, Sandy Nkomo21, Maija Mäki4, Valentina Lorenzoni22, Giuseppe Turchetti22, Clara Carpeggiani3, Stefano Puzzuoli23, Maurizio Mangione23, Paolo Marcheschi23, Daniela Giannessi3, Stephan Nekolla19, Massimo Lombardi8, Rosa Sicari3, Arthur J H A Scholte20, José L Zamorano18, S Richard Underwood21, Juhani Knuuti4, Philipp A Kaufmann2, Danilo Neglia24, Oliver Gaemperli25. 1. 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. 2. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland. 3. Institute of Clinical Physiology, CNR, Pisa, Italy. 4. Heart Center and Turku PET Center, University of Turku, Turku University Hospital, Turku, Finland. 5. Department of Nuclear Medicine, Institute of Cardiology, Warsaw, Poland. 6. Department of Nuclear Medicine, University Hospital Val d'Hebron, Institut Catala de la Salut, Barcelona, Spain. 7. Cardiothoracic Department, Fondazione Toscana G. Monasterio, Pisa, Italy. 8. Imaging Department, Fondazione Toscana G. Monasterio, Pisa, Italy. 9. Department of Cardiology, Alb-Fils-Kliniken, Göppingen, Germany. 10. Emergency Department, Cardiology, Ospedale della Versilia, Lido di Camaiore, Italy. 11. 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. 12. 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. 13. Department of Nuclear Medicine, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France. 14. Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. 15. Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy Don Carlo Gnocchi Foundation, IRCCS, Florence, Italy. 16. Department of Health Science and Internal Medicine, IRCCS Hospital San Martino, National Institute for Cancer Research and University of Genoa, Genoa, Italy. 17. Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy. 18. Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain. 19. Department of Nuclear Medicine, Klinikum Rechts der Isar der Technischen Universität München, Muenchen, Germany. 20. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. 21. Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK. 22. Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy. 23. Technology Department, Fondazione Toscana G. Monasterio, Pisa, Italy. 24. Institute of Clinical Physiology, CNR, Pisa, Italy Cardiothoracic Department, Fondazione Toscana G. Monasterio, Pisa, Italy. 25. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland oliver.gaemperli@usz.ch.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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