Second-Line Myocardial Perfusion Imaging to Detect Obstructive Stenosis

Rasmussen, Laust Dupont; Winther, Simon; Eftekhari, Ashkan; Karim, Salma Raghad; Westra, Jelmer; Isaksen, Christin; Brix, Lau; Ejlersen, June Anita; Murphy, T; Milidonis, Xenios; Nyegaard, Mette; Benovoy, Mitchel; Johansen, Jane Kirk; Søndergaard, Hanne Maare; Hammid, Osama; Mortensen, Jørgen Birk; Knudsen, Lars; Gormsen, Lars Christian; Christiansen, Evald Høj; Chiribiri, Amedeo; Petersen, Steffen E.; Böttcher, Morten

doi:10.1016/j.jcmg.2022.11.015

Cited by 20 publications

(14 citation statements)

References 28 publications

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“…In light of the ISCHEMIA trial,30 one could argue that high-risk CAD should be ruled out by coronary CTA with revascularisation only in patients with medically refractory symptoms regardless of other coronary lesions and lesion severity. Patient selection for ISCHEMIA enrolment, however, was based on moderate/severe ischaemia on non-invasive stress testing which is infrequent in patients with de novo chest pain 12. In our study, no down-classified patients from the ESC-PTP 5% to ≤15% subgroup had prognostic disease, and the enigma of whether one-third of patients with non-obstructive/obstructive CAD and annual event rates <2%24 should be deferred from testing based on a CAD score ≤20 or 197/316 (62.3%) patients with normal coronary arteries should undergo coronary CTA yields further improvements in CL stratification in general (table 2).…”

Section: Discussionmentioning

confidence: 99%

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Likelihood reclassification by an acoustic-based score in suspected coronary artery disease

Rasmussen¹,

Winther²,

Karim

et al. 2023

Heart

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ObjectiveValidation studies of the 2019 European Society of Cardiology pretest probability model (ESC-PTP) for coronary artery disease (CAD) report that 35%–40% of patients have low pretest probability (ESC-PTP 5% to <15%). Acoustic detection of coronary stenoses could potentially improve clinical likelihood stratification. Aims were to (1) investigate the diagnostic performance of an acoustic-based CAD score and (2) study the reclassification potential of a dual likelihood strategy by the ESC-PTP and a CAD score.MethodsConsecutive patients (n=1683) with stable angina symptoms referred for coronary CT angiography (CTA) underwent heart sound analyses by an acoustic CAD-score device. All patients with ≥50% luminal stenosis in any coronary segment at coronary CTA were referred to investigation with invasive coronary angiography (ICA) with fractional flow reserve (FFR).A predefined CAD-score cut-off ≤20 was used to rule out obstructive CAD.ResultsIn total, 439 patients (26%) had ≥50% luminal stenosis on coronary CTA. The subsequent ICA with FFR showed obstructive CAD in 199 patients (11.8%). Using the ≤20 CAD-score cut-off for obstructive CAD rule-out, sensitivity was 85.4% (95% CI 79.7 to 90.0), specificity 40.4% (95% CI 37.9 to 42.9), positive predictive value 16.1% (95% CI 13.9 to 18.5) and negative predictive value 95.4% (95% CI 93.4 to 96.9) in all patients. Applying the cut-off in ESC-PTP 5% to <15% patients, 316 patients (48%) were down-classified to very-low likelihood. The obstructive CAD prevalence was 3.5% in this group.ConclusionIn a large contemporary cohort of patients with low CAD likelihood, the additional use of an acoustic rule-out device showed a clear potential to downgrade likelihood and could supplement current strategies for likelihood assessment to avoid unnecessary testing.Trial registration numberNCT03481712.

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Section: Discussionmentioning

confidence: 99%

“…The Dan-NICAD 2 study protocol,11 including eligibility criteria, and main findings12 have been reported. In summary, 1732 consecutively enrolled patients without known CAD but with symptoms suggestive hereof underwent coronary CTA as first-line diagnostic test from January 2018 to December 2020.…”

Section: Methodsmentioning

confidence: 99%

Likelihood reclassification by an acoustic-based score in suspected coronary artery disease

Rasmussen¹,

Winther²,

Karim

et al. 2023

Heart

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“…The study cohort was previously described in detail. 7,8 The Dan-NICAD 2 (Danish Study of Non-Invasive Testing in Coronary Artery Disease 2) was a prospective, multicenter, open-labeled, randomized, controlled trial including 1732 predominantly low/ intermediate pretest probability patients referred for coronary computed tomography angiography (CTA) due to symptoms suggestive of chronic coronary syndrome. Patients with suspected stenosis on coronary CTA (≥50% diameter stenosis) underwent both CMR and RbPET in randomized order (Figure 1).…”

Section: Patients and Study Designmentioning

confidence: 99%

Myocardial Blood Flow by Magnetic Resonance in Patients With Suspected Coronary Stenosis: Comparison to PET and Invasive Physiology

Rasmussen,

Murphy,

Milidonis

et al. 2024

Circ: Cardiovascular Imaging

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BACKGROUND: Despite recent guideline recommendations, quantitative perfusion (QP) estimates of myocardial blood flow from cardiac magnetic resonance (CMR) have only been sparsely validated. Furthermore, the additional diagnostic value of utilizing QP in addition to the traditional visual expert interpretation of stress-perfusion CMR remains unknown. The aim was to investigate the correlation between myocardial blood flow measurements estimated by CMR, positron emission tomography, and invasive coronary thermodilution. The second aim is to investigate the diagnostic performance of CMR-QP to identify obstructive coronary artery disease (CAD). METHODS: Prospectively enrolled symptomatic patients with >50% diameter stenosis on computed tomography angiography underwent dual-bolus CMR and positron emission tomography with rest and adenosine-stress myocardial blood flow measurements. Subsequently, an invasive coronary angiography (ICA) with fractional flow reserve and thermodilution-based coronary flow reserve was performed. Obstructive CAD was defined as both anatomically severe (>70% diameter stenosis on quantitative coronary angiography) or hemodynamically obstructive (ICA with fractional flow reserve ≤0.80). RESULTS: About 359 patients completed all investigations. Myocardial blood flow and reserve measurements correlated weakly between estimates from CMR-QP, positron emission tomography, and ICA-coronary flow reserve (r<0.40 for all comparisons). In the diagnosis of anatomically severe CAD, the interpretation of CMR-QP by an expert reader improved the sensitivity in comparison to visual analysis alone (82% versus 88% [ P =0.03]) without compromising specificity (77% versus 74% [ P =0.28]). In the diagnosis of hemodynamically obstructive CAD, the accuracy was only moderate for a visual expert read and remained unchanged when additional CMR-QP measurements were interpreted. CONCLUSIONS: CMR-QP correlates weakly to myocardial blood flow measurements by other modalities but improves diagnosis of anatomically severe CAD. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03481712.

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“…Still, CMR assessment of MBF remains in the research realm, 134 and PET MPI is the reference exam for CMVD, 104 displaying higher accuracy, reproducibility, and prognostic value than CMR. 135 , 136 This favours PET in patients at risk of CMVD, particularly women with breast cancer 108 , 137 and patients who underwent chest radiotherapy. 106 , 138 …”

Section: Diagnosis Of Cancer-treatment-related Toxicitymentioning

confidence: 99%

Tales from the future—nuclear cardio-oncology, from prediction to diagnosis and monitoring

Mikaïl

Chequer

Impériale

et al. 2023

European Heart Journal - Cardiovascular Imaging

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Cancer and cardiovascular disease often share common risk factors, and patients with cardiovascular disease who develop cancer are at high risk of experiencing major adverse cardiac events. Additionally, cancer treatment can induce short- and long-term adverse cardiovascular events. Given the improvement in oncological patients’ prognosis, the burden in this vulnerable population is slowly shifting towards increased cardiovascular mortality. Consequently, the field of cardio-oncology is steadily expanding, prompting the need for new markers to stratify and monitor the cardiovascular risk in oncological patients before, during, and after the completion of treatment. Advanced noninvasive cardiac imaging has raised great interest in the early detection of cardiovascular diseases and cardiotoxicity in oncological patients. Nuclear medicine has long been a pivotal exam to robustly assess and monitor the cardiac function of patients undergoing potentially cardiotoxic chemotherapies. In addition, recent radiotracers have shown great interest in the early detection of cancer treatment-related cardiotoxicity. In this review, we summarize the current and emerging nuclear cardiology tools that can help identify cardiotoxicity and assess the cardiovascular risk in patients undergoing cancer treatments, and discuss the specific role of nuclear cardiology alongside other noninvasive imaging techniques.

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Second-Line Myocardial Perfusion Imaging to Detect Obstructive Stenosis

Cited by 20 publications

References 28 publications

Likelihood reclassification by an acoustic-based score in suspected coronary artery disease

Likelihood reclassification by an acoustic-based score in suspected coronary artery disease

Myocardial Blood Flow by Magnetic Resonance in Patients With Suspected Coronary Stenosis: Comparison to PET and Invasive Physiology

Tales from the future—nuclear cardio-oncology, from prediction to diagnosis and monitoring

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