Pei-Ying Hsu1, Wen-Jeng Lee2, Mei-Fang Cheng3, Ruoh-Fang Yen3, Kai-Yuan Tzen3, Yen-Wen Wu4. 1. Department of Nuclear Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin; 2. Department of Medical Imaging; 3. Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei; 4. Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei; ; Cardiology Division of Cardiovascular Medical Center and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City & National Yang-Ming University School of Medicine, Taipei, Taiwan.
Abstract
PURPOSE: Several studies have suggested that a combined approach of stress myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) can provide diagnostic results with excellent accuracy. We aimed to explore whether the addition of CCTA to stress MPI provides incremental diagnostic value in intermediate-to-high cardiovascular risk patients. METHODS: A total of 106 consecutive patients (93 male, 65 ± 10.4 years) underwent coronary artery calcium scoring (CACS), CCTA and (201)Thallium stress MPI before coronary angiography was reviewed. Thirty-seven patients (34.9%) had a history of proven coronary artery disease (CAD) or revascularization procedures, and four had documented non-significant CAD (3.8%). The remaining patients consisted of 17 (16.0%) classified as intermediate, and 48 (45.3%) as the high-risk groups. RESULTS: Obstructive CAD was diagnosed by invasive coronary angiography in 88 patients with 161 vessels. The sensitivity and specificity in a patient-based analysis for obstructive CAD were 99% and 17% for CCTA, 80% and 50% for MPI and 91% and 67% for the combined method, respectively. The per-vessel diagnostic sensitivity and specificity were 95% and 54% for CCTA, 59% and 75% for MPI and 84% and 76% for the combined method. There were significant differences (p < 0.05) when comparing the combined method with MPI or CCTA by areas under the curve in a patient- or vessel-based analysis. However, CACS of 400 or more could not further stratify the patients with obstructive CAD. CONCLUSIONS: CCTA, not CACS, provided additional diagnostic values to stress MPI in patients with intermediate-to-high cardiovascular risk. KEY WORDS: Coronary artery disease (CAD) • Coronary computed tomography angiography (CCTA) • Myocardial perfusion imaging (MPI) • Single-photon emission computed tomography (SPECT).
PURPOSE: Several studies have suggested that a combined approach of stress myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) can provide diagnostic results with excellent accuracy. We aimed to explore whether the addition of CCTA to stress MPI provides incremental diagnostic value in intermediate-to-high cardiovascular risk patients. METHODS: A total of 106 consecutive patients (93 male, 65 ± 10.4 years) underwent coronary artery calcium scoring (CACS), CCTA and (201)Thallium stress MPI before coronary angiography was reviewed. Thirty-seven patients (34.9%) had a history of proven coronary artery disease (CAD) or revascularization procedures, and four had documented non-significant CAD (3.8%). The remaining patients consisted of 17 (16.0%) classified as intermediate, and 48 (45.3%) as the high-risk groups. RESULTS: Obstructive CAD was diagnosed by invasive coronary angiography in 88 patients with 161 vessels. The sensitivity and specificity in a patient-based analysis for obstructive CAD were 99% and 17% for CCTA, 80% and 50% for MPI and 91% and 67% for the combined method, respectively. The per-vessel diagnostic sensitivity and specificity were 95% and 54% for CCTA, 59% and 75% for MPI and 84% and 76% for the combined method. There were significant differences (p < 0.05) when comparing the combined method with MPI or CCTA by areas under the curve in a patient- or vessel-based analysis. However, CACS of 400 or more could not further stratify the patients with obstructive CAD. CONCLUSIONS:CCTA, not CACS, provided additional diagnostic values to stress MPI in patients with intermediate-to-high cardiovascular risk. KEY WORDS: Coronary artery disease (CAD) • Coronary computed tomography angiography (CCTA) • Myocardial perfusion imaging (MPI) • Single-photon emission computed tomography (SPECT).
Authors: Edward A Hulten; Salvatore Carbonaro; Sara P Petrillo; Joshua D Mitchell; Todd C Villines Journal: J Am Coll Cardiol Date: 2010-12-08 Impact factor: 24.094
Authors: Torsten Beck; Christof Burgstahler; Anja Reimann; Axel Kuettner; Martin Heuschmid; Andreas F Kopp; Stephen Schroeder Journal: Nat Clin Pract Cardiovasc Med Date: 2005-07
Authors: Stephen Schroeder; Stephan Achenbach; Frank Bengel; Christof Burgstahler; Filippo Cademartiri; Pim de Feyter; Richard George; Philipp Kaufmann; Andreas F Kopp; Juhani Knuuti; Dieter Ropers; Joanne Schuijf; Laurens F Tops; Jeroen J Bax Journal: Eur Heart J Date: 2007-12-15 Impact factor: 29.983
Authors: Mohamed Mouden; Jan Paul Ottervanger; Jorik R Timmer; Stoffer Reiffers; Ad H J Oostdijk; Siert Knollema; Pieter L Jager Journal: J Nucl Cardiol Date: 2013-12-07 Impact factor: 5.952
Authors: Mohamed Mouden; Jorik R Timmer; Jan Paul Ottervanger; Stoffer Reiffers; Ad H J Oostdijk; Siert Knollema; Pieter L Jager Journal: Eur J Nucl Med Mol Imaging Date: 2012-03-17 Impact factor: 9.236
Authors: Andrew Scott-Moncrieff; Jiao Yang; Daniel Levine; Carolyn Taylor; David Tso; Mark Johnson; Brett Heilbron; Jonathan Leipsic Journal: Can J Cardiol Date: 2011-06-08 Impact factor: 5.223
Authors: R Hachamovitch; D S Berman; L J Shaw; H Kiat; I Cohen; J A Cabico; J Friedman; G A Diamond Journal: Circulation Date: 1998-02-17 Impact factor: 29.690
Authors: Aju P Pazhenkottil; René N Nkoulou; Jelena-Rima Ghadri; Bernhard A Herzog; Ronny R Buechel; Silke M Küest; Mathias Wolfrum; Michael Fiechter; Lars Husmann; Oliver Gaemperli; Philipp A Kaufmann Journal: Eur Heart J Date: 2011-02-14 Impact factor: 29.983
Authors: Rami M Abazid; Osama A Smettei; Akram F Eldesoky; Hanaa Al Saqqah; Habiba S Alenzi; Nora A Altorbak; Sarah S Altorbak; Mehboob Ali Dar Journal: Acta Cardiol Sin Date: 2018-07 Impact factor: 2.672