Detection of Significant Coronary Artery Disease by Noninvasive Anatomical and Functional Imaging

Abstract

Background-The choice of imaging techniques in patients with suspected coronary artery disease (CAD) varies between countries, regions, and hospitals. This prospective, multicenter, comparative effectiveness study was designed to assess the relative accuracy of commonly used imaging techniques for identifying patients with significant CAD. Methods and Results-A total of 475 patients with stable chest pain and intermediate likelihood of CAD underwent coronary computed tomographic angiography and stress myocardial perfusion imaging by single photon emission computed tomography or positron emission tomography, and ventricular wall motion imaging by stress echocardiography or cardiac magnetic resonance. If ≥1 test was abnormal, patients underwent invasive coronary angiography. Significant CAD was defined by invasive coronary angiography as >50% stenosis of the left main stem, >70% stenosis in a major coronary vessel, or 30% to 70% stenosis with fractional flow reserve ≤0.8. Significant CAD was present in 29% of patients. In a patient-based analysis, coronary computed tomographic angiography had the highest diagnostic accuracy, the area under the receiver operating characteristics curve being 0.91 (95% confidence interval, 0.88-0.94), sensitivity being 91%, and specificity being 92%. Myocardial perfusion imaging had good diagnostic accuracy (area under the curve, 0.74;

Ad hoc vs. Non-ad hoc Percutaneous Coronary Intervention Strategies in Patients With Stable Coronary Artery Disease

“…Coronary CT angiography would also help us to anticipate the details of the actual PCI procedure, to perform a heartteam assessment for the treatment strategy before the CAG, and to obtain adequate informed consent from the patient and family members based on the coronary anatomic information specific for the particular patient. 31 Therefore, the use of coronary CT angiography as the initial diagnostic test, timely heart-team approach in severe CAD, and introduction of FFR-guided PCI might be the sine qua non for the appropriate implementation of the ad hoc PCI strategy. In addition, the operators performing ad hoc PCI should not only be experienced, but also know the details of the patient's medical history.…”

PET myocardial perfusion quantification: anatomy of a spreading functional technique

“…Currently, PET is considered the quantitative reference standard myocardial perfusion and it has demonstrated a good performance yielding a sensitivity of 81% and a specificity of 89% for angiographically significant coronary artery stenosis in the recently reported EVINCI trial [29]. Another major study, the PACIFIC trial, demonstrated directly that 15 O-H 2 O PET conveys the best diagnostic performance (in comparison to SPECT and CCTA) with a sensitivity of 87% and a specificity of 84% for the detection of functionally significant lesions evaluated by fractional flow reserve (FFR) [30], the current gold standard for the functional assessment of coronary stenosis [31].…”

Single Photon Emission Computed Tomography in Diagnostics of Obstructive Lesion in Coronary Arteries

“…Различия касаются также предлагаемых неинвазивных тестов: в европейских рекомендациях стресс-тесты с оценкой электрокар-диограммы (ЭКГ) не рекомендуются вовсе [2], в аме-риканских -являются тестами первой линии, а тесты с визуализацией предлагается использовать в случае невозможности интерпретации ЭКГ [1]. Кроме того, в ряде публикацией в качестве неинвазивного теста обосновывается приоритетное использование муль-тиспиральной компьютерной томографии (МСКТ), а не функциональных тестов с визуализацией [6,14,15]. Возможно, выходом из данной ситуации является перенос внимания не на наилучшие неинвазивные методы выявления анатомических изменений КА, а на методы, способные адекватно оценить и корри-гировать прогноз у больных [6,9].…”