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Hybrid SPECT Perfusion Imaging and Coronary CT Angiography: Long-term Prognostic Value for Cardiovascular Outcomes
Aju P Pazhenkottil1, Dominik C Benz1, Christoph Gräni1
1From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland.
Insights
Cardiac hybrid imaging combining SPECT MPI and coronary CT angiography effectively predicts long-term cardiac events. Matched findings of stenosis and ischemia indicate a significantly higher risk for major adverse cardiac events (MACEs).
Area of Science:
- Cardiovascular Imaging
- Nuclear Cardiology
- Radiology
Background:
- Coronary artery disease (CAD) assessment requires accurate long-term risk stratification.
- Hybrid imaging combines functional (SPECT MPI) and anatomical (coronary CT angiography) data for comprehensive evaluation.
Purpose of the Study:
- To evaluate cardiac hybrid imaging as a long-term predictor of major adverse cardiac events (MACEs).
- To assess the prognostic value of matched (stenosis and ischemia in the same territory) versus unmatched findings.
Main Methods:
- Retrospective study of 428 patients undergoing cardiac hybrid imaging (SPECT MPI + coronary CT angiography).
- Patients classified into matched, unmatched, or normal findings groups.
- Kaplan-Meier and Cox regression analyses used to assess MACEs (death, MI, unstable angina, revascularization) over a median 6.8-year follow-up.
Main Results:
- Matched hybrid findings were associated with a significantly higher annual hard event rate (7.0%) compared to normal findings (1.2%).
- MACE rates were 21.8% for matched, 9.0% for unmatched, and 2.4% for normal findings.
- Matched hybrid findings independently predicted MACE and hard events.
Conclusions:
- Cardiac hybrid imaging is an excellent long-term predictor of adverse cardiac events in patients evaluated for CAD.
- A matched hybrid finding signifies a high risk for future cardiac events, underscoring its clinical utility.
Abstract:
Purpose To determine the value of cardiac hybrid imaging, performed by combining SPECT myocardial perfusion imaging (MPI) with coronary CT angiography, as a long-term predictor for major adverse cardiac events (MACEs) (death, myocardial infarction [MI], unstable angina requiring hospitalization, coronary revascularization). Materials and Methods For this retrospective single-center study, 428 patients referred between May 2005 and December 2008 were classified according to hybrid imaging findings into the following groups: (a) those with stenosis of 50% or greater (at coronary CT angiography) with ischemia (at SPECT) in subtended territory (matched), (b) those with coronary CT angiography and/or SPECT findings in unrelated territories (unmatched), and (c) those with normal findings at coronary CT angiography and SPECT. End points were all-cause death or MI ("hard events") and a composite of MACEs. The Kaplan-Meier method was used to identify survival free of MACEs, and Cox proportional hazard regression analysis was used to determine independent predictors for MACE. Results During a median follow-up of 6.8 years, a total of 160 MACEs, including 45 deaths, were observed in the final study population (mean age, 62 years ± 11 [standard deviation]; 132 women). The annual hard event rate was more than fivefold higher for patients with matched findings (n = 46 [7.0%]) and was threefold higher for patients with unmatched findings (n = 113 [3.7%]) compared with that for patients with normal findings (1.2%; n = 216 [1.2%]; P < .001). The MACE rates were 21.8%, 9.0%, and 2.4% for matched, unmatched, and normal findings, respectively. A matched finding was an independent predictor for MACE and hard events. Conclusion In patients evaluated for coronary artery disease, cardiac hybrid imaging is an excellent long-term predictor of adverse cardiac events. A matched hybrid finding is associated with a high annual cardiac event rate. © RSNA, 2018.
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