Diagnosis and Prognosis of Coronary Artery Disease with SPECT and PET

Badarin, Firas J. Al; Malhotra, Saurabh

doi:10.1007/s11886-019-1146-4

Cited by 35 publications

(20 citation statements)

References 67 publications

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“…Besides, the pooled analysis yielded higher sensitivity at the patient level than vessel level. The diagnostic performance in this analysis was not quite similar to previous meta-analyses (27,29). In this study, when FFR was utilized as the reference standard, the AUCs for both CMR and PET were equal.…”

Section: Discussioncontrasting

confidence: 79%

“…In contrast, non-invasive techniques such as CMR, SPECT, and PET embraced higher spatial resolution and low dose of radiation (CMR is free of nuclear radiation); they are undergoing an increase in clinical utility despite the relatively high cost (12,40,41). Nowadays, they remain to be the most reliable approaches for diagnosis of CAD with hemodynamic significance and guide the choice of treatment and assessment prognosis (27).…”

Section: Discussionmentioning

confidence: 99%

“…We conducted a meta-analysis to estimate the performance of CMR, SPECT, and PET for the diagnosis of obstructive CAD. The analysis was based on study design, type of analysis performed in the individual studies, type of radiotracers for SPECT and PET, reference standard, analysis level, and patient selection, some of which have not been discussed in previous meta-analyses (27,29,42). This is one of the strengths of this study.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Performance of CMR, SPECT, and PET Imaging for the Identification of Coronary Artery Disease: A Meta-Analysis

Cai

Geng

et al. 2021

Front. Cardiovasc. Med.

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Background: Myocardial perfusion imaging modalities, such as cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET), are well-established non-invasive diagnostic methods to detect hemodynamically significant coronary artery disease (CAD). The aim of this meta-analysis is to compare CMR, SPECT, and PET in the diagnosis of CAD and to provide evidence for further research and clinical decision-making.Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were searched. Studies that used CMR, SPECT, and/or PET for the diagnosis of CAD were included. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio with their respective 95% confidence interval, and the area under the summary receiver operating characteristic (SROC) curve were calculated.Results: A total of 203 articles were identified for inclusion in this meta-analysis. The pooled sensitivity values of CMR, SPECT, and PET were 0.86, 0.83, and 0.85, respectively. Their respective overall specificity values were 0.83, 0.77, and 0.86. Results in subgroup analysis of the performance of SPECT with 201Tl showed the highest pooled sensitivity [0.85 (0.82, 0.88)] and specificity [0.80 (0.75, 0.83)]. 99mTc-tetrofosmin had the lowest sensitivity [0.76 (0.67, 0.82)]. In the subgroup analysis of PET tracers, results indicated that 13N had the lowest pooled sensitivity [0.83 (0.74, 0.89)], and the specificity was the highest [0.91 (0.81, 0.96)].Conclusion: Our meta-analysis indicates that CMR and PET present better diagnostic performance for the detection of CAD as compared with SPECT.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Diagnostic Performance of CMR, SPECT, and PET Imaging for the Identification of Coronary Artery Disease: A Meta-Analysis

Cai

Geng

et al. 2021

Front. Cardiovasc. Med.

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“…[5] This predictive role has also been demonstrated in subgroups of age, sex, and those with diabetes. [6] More recently, the burden of CAD is increasingly being recognized as an important determinant of patients' outcomes. Studies on measures of CAD burden obtained from CCTA such as segment involvement score (SIS -the total number of coronary artery segments with plaque) have shown how patients can be strati ed across a continuum of risk above a more simplistic binary classi cation by the presence of stenosis.…”

Section: Introductionmentioning

confidence: 99%

Added prognostic value of plaque burden to computed tomography angiography and myocardial perfusion imaging

et al. 2021

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Purpose: Cardiac computed tomographic angiography (CCTA) -derived measures of coronary artery disease (CAD) burden such as segment involvement score (SIS), which quanti es the number of segments with plaque, have been shown to independently predict incident cardiovascular events. We aimed to compare the added prognostic value of plaque burden to CCTA anatomic assessment and single photon emission computed tomography (SPECT) physiologic assessment in a high-risk cohort undergoing both tests.Methods: Consecutive patients who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected CAD at a tertiary care cardiology practice were included. Stenosis severity and SIS were determined from CCTA, and presence of ischemia was determined from SPECT. Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and percutaneous coronary intervention or coronary artery bypass grafting 90-days after imaging test.)Results: A total of 956 patients were included. Mean age was 61.1 ± 14.2 years, 54% were men, 89% had hypertension, 81% had diabetes, 84% had dyslipidemia and 56% had recorded chest pain. Obstructive stenosis (left main ≥ 50%, all other coronary segments ≥ 70%) and ischemia were observed in similar number of patients (14%). After a median follow-up of 31 months, 102 patients (11%, 29.2 events per 1000 person-year) experienced a MACE. In multivariable Cox regression models, SIS signi cantly predicted outcomes and improved risk discrimination in models with CCTA obstructive stenosis (HR 1.15 95% CI 1.09 -1.21 p= <0.001; Harrel's C 0.74, p=0.008) and SPECT ischemia (HR 1.14 95% CI 1.08 -1.20, p<0.001; Harrel's C 0.76, p=0.019). Results were consistent using subgroups by plaque composition (calci ed vs non-calci ed) and lower thresholds of CCTA stenosis. Conclusion:Our results suggest that in high-risk patients with suspected CAD, plaque burden adds incremental prognostic value over established measures in predicting incident cardiovascular outcomes.

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“…Myocardial perfusion imaging (MPI) with singlephoton emission computed tomography (SPECT) is an important noninvasive imaging tool for diagnosis, risk stratification and prognostic evaluation in coronary artery disease (CAD). 1 SPECT MPI evaluates the presence, extent and degree of myocardial ischemia and/or infarction usually through visual observation or semiquantitative parameters. Despite its diagnostic and prognostic values, the relative nature of perfusion images may limit the ability of SPECT to identify patients with high-risk, multivessel CAD.…”

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confidence: 99%