Open Access

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

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Date: 18 March 2016
Journal: European Heart Journal - Cardiovascular Imaging , Volume 17 , Issue 9 , Pages 951 - 960
Authors: S. Aguadé-Bruix , M. Pizzi , G. Todiere , A. Gimelli , D. Chiappino , P. Marraccini , R. Liga , S. Schroeder , T. Drosch , J. Vontobel , R. Poddighe , D. Rovai , M. Marinelli , C. Caselli , M. Pietila , A. Teresinska , G. Casolo , C. Anagnostopoulos , F. Pugliese , F. Rouzet , D. Le Guludec , F. Cappelli , S. Valente , G. Gensini , C. Zawaideh , S. Capitanio , G. Sambuceti , F. Marsico , P. Filardi , C. Fernández-Golfín , L. Rincón , F. Graner , M. de Graaf , J. Stehli , E. Reyes , S. Nkomo , M. Mäki , V. Lorenzoni , G. Turchetti , C. Carpeggiani , S. Puzzuoli , M. Mangione , P. Marcheschi , D. Giannessi , S. Nekolla , M. Lombardi , R. Sicari , A. Scholte , J. Zamorano , S. Underwood , J. Knuuti , P. Kaufmann , D. Neglia , O. Gaemperli

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AbstractAims

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.

About the contributors

Santiago Aguadé-Bruix

Role: Author

Maria Nazarena Pizzi

Role: Author

Giancarlo Todiere

Role: Author