TY - JOUR
T1 - Second-Line Myocardial Perfusion Imaging to Detect Obstructive Stenosis
T2 - Head-to-Head Comparison of CMR and PET
AU - Rasmussen, Laust Dupont
AU - Winther, Simon
AU - Eftekhari, Ashkan
AU - Karim, Salma Raghad
AU - Westra, Jelmer
AU - Isaksen, Christin
AU - Brix, Lau
AU - Ejlersen, June Anita
AU - Murphy, Theodore
AU - Milidonis, Xenios
AU - Nyegaard, Mette
AU - Benovoy, Mitchel
AU - Johansen, Jane Kirk
AU - Søndergaard, Hanne Maare
AU - Hammid, Osama
AU - Mortensen, Jesper
AU - Knudsen, Lars Lyhne
AU - Gormsen, Lars Christian
AU - Christiansen, Evald Høj
AU - Chiribiri, Amedeo
AU - Petersen, Steffen E.
AU - Böttcher, Morten
N1 - Publisher Copyright:
© 2023 American College of Cardiology Foundation
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Background: Guidelines recommend verification of myocardial ischemia by selective second-line myocardial perfusion imaging (MPI) following a coronary computed tomography angiography (CTA) with suspected obstructive coronary artery disease (CAD). Head-to-head data on the diagnostic performance of different MPI modalities in this setting are sparse. Objectives: The authors sought to compare, head-to-head, the diagnostic performance of selective MPI by 3.0-T cardiac magnetic resonance (CMR) and 82rubidium positron emission tomography (RbPET) in patients with suspected obstructive stenosis at coronary CTA using invasive coronary angiography (ICA) with fractional flow reserve (FFR) as reference. Methods: Consecutive patients (n = 1,732, mean age: 59.1 ± 9.5 years, 57.2% men) referred for coronary CTA with symptoms suggestive of obstructive CAD were included. Patients with suspected stenosis were referred for both CMR and RbPET and subsequently ICA. Obstructive CAD was defined as FFR ≤0.80 or >90% diameter stenosis by visual assessment. Results: In total, 445 patients had suspected stenosis on coronary CTA. Of these, 372 patients completed both CMR, RbPET and subsequent ICA with FFR. Hemodynamically obstructive CAD was identified in 164 of 372 (44.1%) patients. Sensitivities for CMR and RbPET were 59% (95% CI: 51%-67%) and 64% (95% CI: 56%-71%); P = 0.21, respectively, and specificities 84% (95% CI: 78%-89%) and 89% (95% CI: 84%-93%]); P = 0.08, respectively. Overall accuracy was higher for RbPET compared with CMR (73% vs 78%; P = 0.03). Conclusions: In patients with suspected obstructive stenosis at coronary CTA, CMR, and RbPET show similar and moderate sensitivities but high specificities compared with ICA with FFR. This patient group represents a diagnostic challenge with frequent mismatch between advanced MPI tests and invasive measurements.
AB - Background: Guidelines recommend verification of myocardial ischemia by selective second-line myocardial perfusion imaging (MPI) following a coronary computed tomography angiography (CTA) with suspected obstructive coronary artery disease (CAD). Head-to-head data on the diagnostic performance of different MPI modalities in this setting are sparse. Objectives: The authors sought to compare, head-to-head, the diagnostic performance of selective MPI by 3.0-T cardiac magnetic resonance (CMR) and 82rubidium positron emission tomography (RbPET) in patients with suspected obstructive stenosis at coronary CTA using invasive coronary angiography (ICA) with fractional flow reserve (FFR) as reference. Methods: Consecutive patients (n = 1,732, mean age: 59.1 ± 9.5 years, 57.2% men) referred for coronary CTA with symptoms suggestive of obstructive CAD were included. Patients with suspected stenosis were referred for both CMR and RbPET and subsequently ICA. Obstructive CAD was defined as FFR ≤0.80 or >90% diameter stenosis by visual assessment. Results: In total, 445 patients had suspected stenosis on coronary CTA. Of these, 372 patients completed both CMR, RbPET and subsequent ICA with FFR. Hemodynamically obstructive CAD was identified in 164 of 372 (44.1%) patients. Sensitivities for CMR and RbPET were 59% (95% CI: 51%-67%) and 64% (95% CI: 56%-71%); P = 0.21, respectively, and specificities 84% (95% CI: 78%-89%) and 89% (95% CI: 84%-93%]); P = 0.08, respectively. Overall accuracy was higher for RbPET compared with CMR (73% vs 78%; P = 0.03). Conclusions: In patients with suspected obstructive stenosis at coronary CTA, CMR, and RbPET show similar and moderate sensitivities but high specificities compared with ICA with FFR. This patient group represents a diagnostic challenge with frequent mismatch between advanced MPI tests and invasive measurements.
KW - cardiac magnetic resonance
KW - chronic coronary syndrome
KW - coronary artery disease
KW - fractional flow reserve
KW - myocardial perfusion imaging
KW - positron emission tomography
UR - http://www.scopus.com/inward/record.url?scp=85152881623&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2022.11.015
DO - 10.1016/j.jcmg.2022.11.015
M3 - Article
C2 - 36881421
AN - SCOPUS:85152881623
SN - 1936-878X
VL - 16
SP - 642
EP - 655
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 5
ER -
