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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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.
AuthorsLiga, R; Vontobel, J; Rovai, D; Marinelli, M; Caselli, C; Pietila, M; Teresinska, A; Aguadé-Bruix, S; Pizzi, MN; Todiere, G; Gimelli, A; Chiappino, D; Marraccini, P; Schroeder, S; Drosch, T; Poddighe, R; Casolo, G; Anagnostopoulos, C; Pugliese, F; Rouzet, F; Le Guludec, D; Cappelli, F; Valente, S; Gensini, GF; Zawaideh, C; Capitanio, S; Sambuceti, G; Marsico, F; Filardi, PP; Fernández-Golfín, C; Rincón, LM; Graner, FP; de Graaf, MA; Stehli, J; Reyes, E; Nkomo, S; Mäki, M; Lorenzoni, V; Turchetti, G; Carpeggiani, C; Puzzuoli, S; Mangione, M; Marcheschi, P; Giannessi, D; Nekolla, S; Lombardi, M; Sicari, R; Scholte, AJ; Zamorano, JL; Underwood, SR; Knuuti, J; Kaufmann, PA; Neglia, D; Gaemperli, O; EVINCI Study Investigators,
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