Comparison of Coronary CT Angiography, SPECT, PET, and Hybrid Imaging for Diagnosis of Ischemic Heart Disease Determined by Fractional Flow Reserve
Ibrahim Danad,Pieter G. Raijmakers,Roel S. Driessen,Jonathon Leipsic,Rekha Raju,Christopher Naoum,Juhani Knuuti,Maija Mäki,Richard S. Underwood,James K. Min,James K. Min,Kimberly Elmore,Kimberly Elmore,W J Stuijfzand,Niels van Royen,Igor I. Tulevski,Aernout G. Somsen,Marc C. Huisman,Arthur van Lingen,Martijn W. Heymans,Peter M. van de Ven,Cornelis van Kuijk,Adriaan A. Lammertsma,Albert C. van Rossum,Paul Knaapen +24 more
TLDR
This controlled clinical head-to-head comparative study revealed PET to exhibit the highest accuracy for diagnosis of myocardial ischemia and a combined anatomical and functional assessment does not add incremental diagnostic value but guides clinical decision-making in an unsalutary fashion.Abstract:
Importance At present, the choice of noninvasive testing for a diagnosis of significant coronary artery disease (CAD) is ambiguous, but nuclear myocardial perfusion imaging with single-photon emission tomography (SPECT) or positron emission tomography (PET) and coronary computed tomography angiography (CCTA) is predominantly used for this purpose. However, to date, prospective head-to-head studies are lacking regarding the diagnostic accuracy of these imaging modalities. Furthermore, the combination of anatomical and functional assessments configuring a hybrid approach may yield improved accuracy. Objectives To establish the diagnostic accuracy of CCTA, SPECT, and PET and explore the incremental value of hybrid imaging compared with fractional flow reserve. Design, Setting, and Participants A prospective clinical study involving 208 patients with suspected CAD who underwent CCTA, technetium 99m/tetrofosmin–labeled SPECT, and [ 15 O]H 2 O PET with examination of all coronary arteries by fractional flow reserve was performed from January 23, 2012, to October 25, 2014. Scans were interpreted by core laboratories on an intention-to-diagnose basis. Hybrid images were generated in case of abnormal noninvasive anatomical or functional test results. Main Outcomes and Measures Hemodynamically significant stenosis in at least 1 coronary artery as indicated by a fractional flow reserve of 0.80 or less and relative diagnostic accuracy of SPECT, PET, and CCTA in detecting hemodynamically significant CAD. Results Of the 208 patients in the study (76 women and 132 men; mean [SD] age, 58 [9] years), 92 (44.2%) had significant CAD (fractional flow reserve ≤0.80). Sensitivity was 90% (95% CI, 82%-95%) for CCTA, 57% (95% CI, 46%-67%) for SPECT, and 87% (95% CI, 78%-93%) for PET, whereas specificity was 60% (95% CI, 51%-69%) for CCTA, 94% (95% CI, 88%-98%) for SPECT, and 84% (95% CI, 75%-89%) for PET. Single-photon emission tomography was found to be noninferior to PET in terms of specificity ( P P > .99) using the predefined absolute margin of 10%. Diagnostic accuracy was highest for PET (85%; 95% CI, 80%-90%) compared with that of CCTA (74%; 95% CI, 67%-79%; P = .003) and SPECT (77%; 95% CI, 71%-83%; P = .02). Diagnostic accuracy was not enhanced by either hybrid SPECT and CCTA (76%; 95% CI, 70%-82%; P = .75) or by PET and CCTA (84%; 95% CI, 79%-89%; P = .82), but resulted in an increase in specificity ( P = .004) at the cost of a decrease in sensitivity ( P = .001). Conclusions and Relevance This controlled clinical head-to-head comparative study revealed PET to exhibit the highest accuracy for diagnosis of myocardial ischemia. Furthermore, a combined anatomical and functional assessment does not add incremental diagnostic value but guides clinical decision-making in an unsalutary fashion.read more
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2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Martha Gulati,Phillip D. Levy,Debabrata Mukherjee,Ezra A. Amsterdam,Deepak L. Bhatt,Kim K. Birtcher,Ron Blankstein,Jack H. Boyd,Renee P. Bullock-Palmer,Theresa Conejo,Deborah B. Diercks,Federico Gentile,John P Greenwood,Erik P. Hess,Steven M. Hollenberg,Wael A Jaber,Hani Jneid,Jose A. Joglar,David A. Morrow,Robert E. O'Connor,Michael A. Ross,Leslee J. Shaw +21 more
TL;DR: The 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain this paper provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain.
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Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction
Viviany R. Taqueti,Scott D. Solomon,Amil M. Shah,Akshay S. Desai,John D. Groarke,Michael T. Osborne,Jon Hainer,Courtney F. Bibbo,Sharmila Dorbala,Ron Blankstein,Marcelo F. Di Carli +10 more
TL;DR: In symptomatic patients without overt CAD, impaired CFR was independently associated with diastolic dysfunction and adverse events, especially HFpEF hospitalization, and the presence of both coronary microvascular and diastsolic dysfunctions was associated with a markedly increased risk ofHFpEF events.
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Comparison of Coronary Computed Tomography Angiography, Fractional Flow Reserve, and Perfusion Imaging for Ischemia Diagnosis
Roel S. Driessen,Ibrahim Danad,Wijnand J. Stuijfzand,Pieter G. Raijmakers,Stefan P. Schumacher,Pepijn A. van Diemen,Jonathon Leipsic,Juhani Knuuti,S. Richard Underwood,Peter M. van de Ven,Albert C. van Rossum,Charles A. Taylor,Paul Knaapen +12 more
TL;DR: In patients in whom 3-vessel F FRCT could be analyzed, FFRCT holds clinical potential to provide anatomic and hemodynamic significance of coronary lesions, and showed higher diagnostic performance than standard coronary CTA, SPECT, and PET for vessel-specific ischemia.
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2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain
Martha Gulati,Phillip D. Levy,Debabrata Mukherjee,Ezra A. Amsterdam,Deepak L. Bhatt,Kim K. Birtcher,Ron Blankstein,Jack H. Boyd,Renee P. Bullock-Palmer,Theresa Conejo,Deborah B. Diercks,Federico Gentile,John P Greenwood,Erik P. Hess,Steven M. Hollenberg,Wael A. Jaber,Hani Jneid,Jose A. Joglar,David A. Morrow,Robert E. O'Connor,Michael A. Ross,Leslee J. Shaw +21 more
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SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography.
Jagat Narula,Y S Chandrashekhar,Amir Ahmadi,Suhny Abbara,Daniel S. Berman,Ron Blankstein,Jonathon Leipsic,David E. Newby,Edward D. Nicol,Koen Nieman,Leslee J. Shaw,Todd C. Villines,Michelle C. Williams,Harvey S. Hecht +13 more
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Fractional flow reserve versus angiography for guiding percutaneous coronary intervention
Bernard De Bruyne,Uwe Siebert,Fumiaki Ikeno,Volker Klauss,Ganesh Manoharan,Thomas Engstrøm,Keith G. Oldroyd,Peter N. Ver Lee,Philip MacCarthy,William F. Fearon +9 more
TL;DR: Routine measurement of FFR in patients with multivessel coronary artery disease who are undergoing PCI with drug-eluting stents significantly reduces the rate of the composite end point of death, nonfatal myocardial infarction, and repeat revascularization at 1 year.
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Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease
Bernard De Bruyne,Bindu Kalesan,Emanuele Barbato,Zsolt Piroth,Nikola Jagic,Sven Mobius-Winckler,Gilles Rioufol,Nils Witt,Petr Kala,Philip MacCarthy,Thomas Engstrøm,Keith G. Oldroyd,Kreton Mavromatis,Ganesh Manoharan,Peter Verlee,Ole Fröbert,Nick Curzen,Jane B. Johnson,Peter Jüni,William F. Fearon,Trial Investigators +20 more
TL;DR: In patients with stable coronary artery disease and functionally significant stenoses, FFR-guided PCI plus the best available medical therapy, as compared with the best Available medical therapy alone, decreased the need for urgent revascularization.
Journal ArticleDOI
Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease
Pamela S. Douglas,Udo Hoffmann,Manesh R. Patel,Daniel B. Mark,Hussein R. Al-Khalidi,Brendan Cavanaugh,Jason Cole,Rowena J. Dolor,Christopher B. Fordyce,Megan Huang,Muhammad Akram Khan,Andrzej S. Kosinski,Mitchell W. Krucoff,Vinay Malhotra,Michael H. Picard,James E. Udelson,Eric J. Velazquez,Eric Yow,Lawton S. Cooper,Kerry L. Lee,Abstr Act +20 more
TL;DR: In symptomatic patients with suspected CAD who required noninvasive testing, a strategy of initial CTA, as compared with functional testing, did not improve clinical outcomes over a median follow-up of 2 years.
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2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology.
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