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. (18th March 2016)

• Record Type: Journal Article
• Authors: Liga, Riccardo; Vontobel, Jan; Rovai, Daniele; Marinelli, Martina; Caselli, Chiara; Pietila, Mikko; Teresinska, Anna; Aguadé-Bruix, Santiago; Pizzi, Maria Nazarena; Todiere, Giancarlo; Gimelli, Alessia; Chiappino, Dante; Marraccini, Paolo; Schroeder, Stephen; Drosch, Tanja; Poddighe, Rosa; Casolo, Giancarlo; Anagnostopoulos, Constantinos; Pugliese, Francesca; Rouzet, Francois; Le Guludec, Dominique; Cappelli, Francesco; Valente, Serafina; Gensini, Gian Franco; Zawaideh, Camilla; Capitanio, Selene; Sambuceti, Gianmario; Marsico, Fabio; Filardi, Pasquale Perrone; Fernández-Golfín, Covadonga; Rincón, Luis M.; Graner, Frank P.; de Graaf, Michiel A.; Stehli, Julia; Reyes, Eliana; Nkomo, Sandy; Mäki, Maija; Lorenzoni, Valentina; Turchetti, Giuseppe; Carpeggiani, Clara; Puzzuoli, Stefano; Mangione, Maurizio; Marcheschi, Paolo; Giannessi, Daniela; Nekolla, Stephan; Lombardi, Massimo; Sicari, Rosa; Scholte, Arthur J.H.A.; Zamorano, José L.; Underwood, S. Richard; Knuuti, Juhani; Kaufmann, Philipp A.; Neglia, Danilo; Gaemperli, Oliver;
• Is Part Of: European heart journal. Volume 17:Number 9(2016:Sep.)
• Page Start: 951
• Page End: 960
• Publication Date: 2016-03-18
• Subjects: Hybrid imaging -- Myocardial perfusion scintigraphy -- CT coronary angiography -- Coronary artery disease; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jew038
• Languages: English
• ISSNs: 2047-2404

Abstract

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.