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Added value of hybrid myocardial perfusion SPECT and CT coronary angiography in the diagnosis of coronary artery disease.
Schaap, Jeroen; de Groot, Joris A H; Nieman, Koen; Meijboom, W Bob; Boekholdt, S Matthijs; Kauling, Robert M; Post, Martijn C; Van der Heyden, Jan A; de Kroon, Thom L; Rensing, Benno J W M; Moons, Karel G M; Verzijlbergen, J Fred.
Afiliación
  • Schaap J; Department of Cardiology, Amphia Hospital, PO Box 90158, 4800 RK, Breda, The Netherlands Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands jeroenschaap01@gmail.com.
  • de Groot JA; Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
  • Nieman K; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
  • Meijboom WB; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
  • Boekholdt SM; Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
  • Kauling RM; Department of Cardiology, Amphia Hospital, PO Box 90158, 4800 RK, Breda, The Netherlands.
  • Post MC; Department of Cardiology, Amphia Hospital, PO Box 90158, 4800 RK, Breda, The Netherlands.
  • Van der Heyden JA; Department of Cardiology, Amphia Hospital, PO Box 90158, 4800 RK, Breda, The Netherlands.
  • de Kroon TL; Department of Cardio-Thoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
  • Rensing BJ; Department of Cardiology, Amphia Hospital, PO Box 90158, 4800 RK, Breda, The Netherlands.
  • Moons KG; Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
  • Verzijlbergen JF; Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
Eur Heart J Cardiovasc Imaging ; 15(11): 1281-8, 2014 Nov.
Article en En | MEDLINE | ID: mdl-25073595
AIMS: Hybrid single photon emission computed tomography (SPECT)/coronary computed tomography angiography (CCTA) has only been evaluated for its diagnostic accuracy as a single test in patients suspected of significant coronary artery disease (CAD). Added value of hybrid SPECT/CCTA beyond usual clinical work-up, or use of each of these tests separately, remains unclear. We evaluated the added value of hybrid myocardial perfusion SPECT (SPECT) and CCTA, beyond pre-test likelihood and exercise stress ECG (X-ECG), in the diagnosis of CAD. METHODS AND RESULTS: Two hundred and five patients with stable angina pectoris and intermediate-to-high pre-test likelihood were prospectively included. All patients underwent clinical history and examination, X-ECG, stress and rest SPECT, coronary calcium scoring (CCS) and CCTA. Fractional flow reserve measurement <0.80 or a lesion >50% on coronary angiography (CA) served as reference standard for significant CAD. Multiple imputation was used to correct for missing test results (17-20%). Added value of hybrid SPECT/CCTA to the basic model of pre-test likelihood plus X-ECG was quantified using logistic regression analysis. Model differences were then assessed using differences in C-index and in net reclassification improvement (NRI). The basic model had a C-index of 0.73 (95%CI 0.66-0.80). This significantly increased to 0.85 (95%CI 0.80-0.91) by addition of only SPECT, to 0.90 (95%CI 0.85-0.94) when adding only CCTA, and to 0.96 (95%CI 0.92-0.99) when adding hybrid SPECT/CCTA. The accompanying NRIs were 0.82 (95%CI 0.62-1.02), 0.86 (95%CI 0.66-1.06) and 1.57 (95%CI 1.11-1.59) respectively. CONCLUSION: Current analysis resembles clinical routine of layered testing and shows that hybrid SPECT/CCTA imaging has a substantially higher yield than standalone SPECT or CCTA in the diagnostic workup of patients suspected of significant CAD.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Tomografía Computarizada por Rayos X / Tomografía Computarizada de Emisión de Fotón Único / Angiografía Coronaria / Imagen Multimodal Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Eur Heart J Cardiovasc Imaging Año: 2014 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Tomografía Computarizada por Rayos X / Tomografía Computarizada de Emisión de Fotón Único / Angiografía Coronaria / Imagen Multimodal Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Eur Heart J Cardiovasc Imaging Año: 2014 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Reino Unido