Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
Eur Heart J Cardiovasc Imaging. 2013 Jul;14(7):642-9. doi: 10.1093/ehjci/jes303. Epub 2013 Jan 4.
Hybrid myocardial perfusion imaging with single photon emission computed tomography (SPECT) and CT coronary angiography (CCTA) has the potential to play a major role in patients with non-conclusive SPECT or CCTA results. We evaluated the performance of hybrid SPECT/CCTA vs. standalone SPECT and CCTA for the diagnosis of significant coronary artery disease (CAD) in patients with an intermediate to high pre-test likelihood of CAD.
In total, 98 patients (mean age 62.5 ± 10.1 years, 68.4% male) with stable anginal complaints and a median pre-test likelihood of 87% (range 22-95%) were prospectively included in this study. Hybrid SPECT/CCTA was performed prior to conventional coronary angiography (CA) including fractional flow reserve (FFR) measurements. Hybrid analysis was performed by combined interpretation of SPECT and CCTA images. The sensitivity, specificity, positive (PPV), and negative (NPV) predictive values were calculated for standalone SPECT, CCTA, and hybrid SPECT/CCTA on per patient level, using an FFR <0.80 as a reference for significant CAD. Significant CAD was demonstrated in 56 patients (57.9%). Non-conclusive SPECT or CCTA results were found in 32 (32.7%) patients. SPECT had a sensitivity of 93%, specificity 79%, PPV 85%, and NPV 89%. CCTA had a sensitivity of 98%, specificity 62%, PPV 77%, and NPV 96%. Hybrid analysis of SPECT and CCTA improved the overall performance: sensitivity, specificity, PPV, and NPV for the presence of significant CAD to 96, 95, 96, and 95%, respectively.
In > 40% of the patients with a high pre-test likelihood no significant CAD was demonstrated, emphasizing the value of accurate pre-treatment cardiovascular imaging. Hybrid SPECT/CCTA was able to accurately diagnose and exclude significant CAD surpassing standalone myocardial SPECT and CCTA, vs. a reference standard of FFR measurements.
单光子发射计算机断层扫描（SPECT）与 CT 冠状动脉造影（CCTA）相结合的混合心肌灌注成像在 SPECT 或 CCTA 结果不确定的患者中具有重要作用。我们评估了混合 SPECT/CCTA 与单独 SPECT 和 CCTA 对中高危冠心病（CAD）患者的诊断效能。
本研究共纳入 98 例（平均年龄 62.5 ± 10.1 岁，68.4%为男性）有稳定型心绞痛症状且中位预测试验可能性为 87%（范围 22%-95%）的患者。所有患者均进行了混合 SPECT/CCTA 检查，然后进行常规冠状动脉造影（CA），包括血流储备分数（FFR）测量。混合分析通过联合 SPECT 和 CCTA 图像进行。以 FFR<0.80 作为有意义 CAD 的参考标准，分别计算每位患者单独 SPECT、CCTA 和混合 SPECT/CCTA 的敏感度、特异度、阳性预测值（PPV）和阴性预测值（NPV）。56 例患者（57.9%）存在有意义 CAD。32 例患者（32.7%）的 SPECT 或 CCTA 结果不确定。SPECT 的敏感度为 93%，特异度为 79%，PPV 为 85%，NPV 为 89%。CCTA 的敏感度为 98%，特异度为 62%，PPV 为 77%，NPV 为 96%。SPECT 和 CCTA 的混合分析提高了整体性能：存在有意义 CAD 的患者的敏感性、特异性、PPV 和 NPV 分别提高至 96%、95%、96%和 95%。
40%的高预测试验可能性患者中未发现有意义 CAD，这强调了准确的术前心血管成像的价值。混合 SPECT/CCTA 能够准确诊断和排除有意义 CAD，优于 FFR 测量的参考标准。
