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Updated: May 5, 2026
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Published on: December 19, 2013
Prognostic value of cardiac hybrid imaging integrating single-photon emission computed tomography with coronary
Aju P Pazhenkottil1, René N Nkoulou, Jelena-Rima Ghadri
1Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland. pak@usz.ch
Insights
Cardiac hybrid imaging, combining SPECT and CCTA, effectively predicts major adverse cardiac events. A matched defect on hybrid images is a strong indicator of increased risk in coronary artery disease patients.
Area of Science:
- Cardiology
- Radiology
- Nuclear Medicine
Background:
- Cardiac hybrid imaging fuses SPECT myocardial perfusion imaging and CCTA for comprehensive coronary artery disease (CAD) assessment.
- Prognostic data on the predictive value of hybrid imaging for CAD outcomes were previously lacking.
Purpose of the Study:
- To evaluate the prognostic value of fused cardiac hybrid imaging (SPECT/CCTA) in patients with known or suspected CAD.
- To assess the predictive capability of hybrid imaging findings for major adverse cardiac events (MACE).
Main Methods:
- 335 patients underwent 1-day stress/rest Tc-99m-tetrofosmin SPECT and CCTA, with images fused for hybrid analysis.
- Patients were categorized based on matched or unmatched findings between CCTA and SPECT, or normal findings.
- Kaplan-Meier analysis and Cox regression identified predictors of MACE (death, MI, unstable angina, revascularization) over a median follow-up of 2.8 years.
Main Results:
- A matched finding of coronary stenosis on CCTA and reversible defect on SPECT was significantly associated with higher death/MI incidence (P < 0.005).
- Hybrid imaging findings independently predicted MACE.
- Annual death/MI rates were 6.0% for matched findings, 2.8% for unmatched, and 1.3% for normal findings.
Conclusions:
- Cardiac hybrid imaging (SPECT/CCTA) enables effective risk stratification in patients with CAD.
- A matched defect on hybrid images is a powerful independent predictor of MACE, highlighting its prognostic significance.
Abstract:
Aims Although cardiac hybrid imaging, fusing single-photon emission computed tomography (SPECT) myocardial perfusion imaging with coronary computed tomography angiography (CCTA), provides important complementary diagnostic information for coronary artery disease (CAD) assessment, no prognostic data exist on the predictive value of cardiac hybrid imaging. Hence, the aim of this study was to assess the prognostic value of hybrid SPECT/CCTA images. Methods and results Of 335 consecutive patients undergoing a 1-day stress/rest (99m)Tc-tetrofosmin SPECT and a CCTA, acquired on stand-alone scanners and fused to obtain cardiac hybrid images, follow-up was obtained in 324 patients (97%). Survival free of all-cause death or non-fatal myocardial infarction (MI) and free of major adverse cardiac events (MACE: death, MI, unstable angina requiring hospitalization, coronary revascularizations) was determined using the Kaplan-Meier method for the following groups: (i) stenosis by CCTA and matching reversible SPECT defect; (ii) unmatched CCTA and SPECT finding; and (iii) normal finding by CCTA and SPECT. Cox's proportional hazard regression was used to identify independent predictors for cardiac events. At a median follow-up of 2.8 years (25th-75th percentile: 1.9-3.6), 69 MACE occurred in 47 patients, including 20 death/MI. A corresponding matched hybrid image finding was associated with a significantly higher death/MI incidence (P < 0.005) and proved to be an independent predictor for MACE. The annual death/MI rate was 6.0, 2.8, and 1.3% for patients with matched, unmatched, and normal findings. Conclusion Cardiac hybrid imaging allows risk stratification in patients with known or suspected CAD. A matched defect on hybrid image is a strong predictor of MACE.
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