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
Riccardo Liga, Jan Vontobel, Daniele Rovai, Martina Marinelli, Chiara Caselli, Mikko Pietila, Anna Teresinska, Santiago Aguadé-Bruix, Maria Nazarena Pizzi, Giancarlo Todiere, Alessia Gimelli, Dante Chiappino, Paolo Marraccini, Stephen Schroeder, Tanja Drosch, Rosa Poddighe, Giancarlo Casolo, Constantinos Anagnostopoulos, Francesca Pugliese, Francois Rouzet, Dominique Le Guludec, Francesco Cappelli, Serafina Valente, Gian Franco Gensini, Camilla Zawaideh, Selene Capitanio, Gianmario Sambuceti, Fabio Marsico, Pasquale Perrone Filardi, Covadonga Fernández-Golfín, Luis M Rincón, Frank P Graner, Michiel A de Graaf, Julia Stehli, Eliana Reyes, Sandy Nkomo, Maija Mäki, Valentina Lorenzoni, Giuseppe Turchetti, Clara Carpeggiani, Stefano Puzzuoli, Maurizio Mangione, Paolo Marcheschi, Daniela Giannessi, Stephan Nekolla, Massimo Lombardi, Rosa Sicari, Arthur J H A Scholte, José L Zamorano, S Richard Underwood, Juhani Knuuti, Philipp A Kaufmann, Danilo Neglia, Oliver Gaemperli, EVINCI Study Investigators, Riccardo Liga, Jan Vontobel, Daniele Rovai, Martina Marinelli, Chiara Caselli, Mikko Pietila, Anna Teresinska, Santiago Aguadé-Bruix, Maria Nazarena Pizzi, Giancarlo Todiere, Alessia Gimelli, Dante Chiappino, Paolo Marraccini, Stephen Schroeder, Tanja Drosch, Rosa Poddighe, Giancarlo Casolo, Constantinos Anagnostopoulos, Francesca Pugliese, Francois Rouzet, Dominique Le Guludec, Francesco Cappelli, Serafina Valente, Gian Franco Gensini, Camilla Zawaideh, Selene Capitanio, Gianmario Sambuceti, Fabio Marsico, Pasquale Perrone Filardi, Covadonga Fernández-Golfín, Luis M Rincón, Frank P Graner, Michiel A de Graaf, Julia Stehli, Eliana Reyes, Sandy Nkomo, Maija Mäki, Valentina Lorenzoni, Giuseppe Turchetti, Clara Carpeggiani, Stefano Puzzuoli, Maurizio Mangione, Paolo Marcheschi, Daniela Giannessi, Stephan Nekolla, Massimo Lombardi, Rosa Sicari, Arthur J H A Scholte, José L Zamorano, S Richard Underwood, Juhani Knuuti, Philipp A Kaufmann, Danilo Neglia, Oliver Gaemperli, EVINCI Study Investigators
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.
Keywords: CT coronary angiography; Coronary artery disease; Hybrid imaging; Myocardial perfusion scintigraphy.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.
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Source: PubMed