Second-Line Myocardial Perfusion Imaging to Detect Obstructive Stenosis: Head-to-Head Comparison of CMR and PET

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

doi:10.1016/j.jcmg.2022.11.015

Second-Line Myocardial Perfusion Imaging to Detect Obstructive Stenosis: Head-to-Head Comparison of CMR and PET

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

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Abstract

Background: Guidelines recommend verification of myocardial ischemia by selective second-line myocardial perfusion imaging (MPI) following a coronary computed tomography angiography (CTA) with suspected obstructive coronary artery disease (CAD). Head-to-head data on the diagnostic performance of different MPI modalities in this setting are sparse.

Objectives: The authors sought to compare, head-to-head, the diagnostic performance of selective MPI by 3.0-T cardiac magnetic resonance (CMR) and 82rubidium positron emission tomography (RbPET) in patients with suspected obstructive stenosis at coronary CTA using invasive coronary angiography (ICA) with fractional flow reserve (FFR) as reference.

Methods: Consecutive patients (n = 1,732, mean age: 59.1 ± 9.5, 57.2% men) referred for coronary CTA with symptoms suggestive of obstructive CAD were included. Patients with suspected stenosis were referred for both CMR and RbPET and subsequently ICA. Obstructive CAD was defined as FFR ≤0.80 or >90% diameter stenosis by visual assessment.

Results: In total, 445 patients had suspected stenosis on coronary CTA. Of these, 372 patients completed both CMR, RbPET and subsequent ICA with FFR. Hemodynamically obstructive CAD was identified in 164 of 372 (44.1%) patients. Sensitivities for CMR and RbPET were 59% (95% CI: 51%-67%) and 64% (95% CI: 56%-71%); P = 0.21, respectively, and specificities 84% (95% CI: 78%-89%) and 89% (95% CI: 84%-93%]); P = 0.08, respectively. Overall accuracy was higher for RbPET compared with CMR (73% vs 78%; P = 0.03).

Conclusions: In patients with suspected obstructive stenosis at coronary CTA, CMR, and RbPET show similar and moderate sensitivities but high specificities compared with ICA with FFR. This patient group represents a diagnostic challenge with frequent mismatch between advanced MPI tests and invasive measurements. (Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease 2 [Dan-NICAD 2]; NCT03481712).

Originalsprog	Engelsk
Tidsskrift	JACC: Cardiovascular Imaging
Vol/bind	16
Udgave nummer	5
Sider (fra-til)	642-655
Antal sider	14
ISSN	1936-878X
DOI	https://doi.org/10.1016/j.jcmg.2022.11.015
Status	Udgivet - maj 2023

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Rasmussen, L. D., Winther, S., Eftekhari, A., Karim, S. R., Westra, J., Isaksen, C., Brix, L., Ejlersen, J. A., Murphy, T., Milidonis, X., Nyegaard, M., Benovoy, M., Johansen, J. K., Søndergaard, H. M., Hammid, O., Mortensen, J., Knudsen, L. L., Gormsen, L. C., Christiansen, E. H., ... Böttcher, M. (2023). Second-Line Myocardial Perfusion Imaging to Detect Obstructive Stenosis: Head-to-Head Comparison of CMR and PET. JACC: Cardiovascular Imaging, 16(5), 642-655. Advance online publication. https://doi.org/10.1016/j.jcmg.2022.11.015

@article{a054661eba8f4c9aa6ef66dd0a7b4bc4,

title = "Second-Line Myocardial Perfusion Imaging to Detect Obstructive Stenosis: Head-to-Head Comparison of CMR and PET",

abstract = "Background: Guidelines recommend verification of myocardial ischemia by selective second-line myocardial perfusion imaging (MPI) following a coronary computed tomography angiography (CTA) with suspected obstructive coronary artery disease (CAD). Head-to-head data on the diagnostic performance of different MPI modalities in this setting are sparse. Objectives: The authors sought to compare, head-to-head, the diagnostic performance of selective MPI by 3.0-T cardiac magnetic resonance (CMR) and 82rubidium positron emission tomography (RbPET) in patients with suspected obstructive stenosis at coronary CTA using invasive coronary angiography (ICA) with fractional flow reserve (FFR) as reference. Methods: Consecutive patients (n = 1,732, mean age: 59.1 ± 9.5 years, 57.2% men) referred for coronary CTA with symptoms suggestive of obstructive CAD were included. Patients with suspected stenosis were referred for both CMR and RbPET and subsequently ICA. Obstructive CAD was defined as FFR ≤0.80 or >90% diameter stenosis by visual assessment. Results: In total, 445 patients had suspected stenosis on coronary CTA. Of these, 372 patients completed both CMR, RbPET and subsequent ICA with FFR. Hemodynamically obstructive CAD was identified in 164 of 372 (44.1%) patients. Sensitivities for CMR and RbPET were 59% (95% CI: 51%-67%) and 64% (95% CI: 56%-71%); P = 0.21, respectively, and specificities 84% (95% CI: 78%-89%) and 89% (95% CI: 84%-93%]); P = 0.08, respectively. Overall accuracy was higher for RbPET compared with CMR (73% vs 78%; P = 0.03). Conclusions: In patients with suspected obstructive stenosis at coronary CTA, CMR, and RbPET show similar and moderate sensitivities but high specificities compared with ICA with FFR. This patient group represents a diagnostic challenge with frequent mismatch between advanced MPI tests and invasive measurements.",

keywords = "cardiac magnetic resonance, chronic coronary syndrome, coronary artery disease, fractional flow reserve, myocardial perfusion imaging, positron emission tomography",

author = "Rasmussen, {Laust Dupont} and Simon Winther and Ashkan Eftekhari and Karim, {Salma Raghad} and Jelmer Westra and Christin Isaksen and Lau Brix and Ejlersen, {June Anita} and Theodore Murphy and Xenios Milidonis and Mette Nyegaard and Mitchel Benovoy and Johansen, {Jane Kirk} and S{\o}ndergaard, {Hanne Maare} and Osama Hammid and Jesper Mortensen and Knudsen, {Lars Lyhne} and Gormsen, {Lars Christian} and Christiansen, {Evald H{\o}j} and Amedeo Chiribiri and Petersen, {Steffen E.} and Morten B{\"o}ttcher",

year = "2023",

month = may,

doi = "10.1016/j.jcmg.2022.11.015",

language = "English",

volume = "16",

pages = "642--655",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier",

number = "5",

}

Rasmussen, LD, Winther, S, Eftekhari, A, Karim, SR, Westra, J, Isaksen, C, Brix, L, Ejlersen, JA, Murphy, T, Milidonis, X, Nyegaard, M, Benovoy, M, Johansen, JK, Søndergaard, HM, Hammid, O, Mortensen, J, Knudsen, LL, Gormsen, LC, Christiansen, EH, Chiribiri, A, Petersen, SE & Böttcher, M 2023, 'Second-Line Myocardial Perfusion Imaging to Detect Obstructive Stenosis: Head-to-Head Comparison of CMR and PET', JACC: Cardiovascular Imaging, bind 16, nr. 5, s. 642-655. https://doi.org/10.1016/j.jcmg.2022.11.015

TY - JOUR

T1 - Second-Line Myocardial Perfusion Imaging to Detect Obstructive Stenosis: Head-to-Head Comparison of CMR and PET

AU - Rasmussen, Laust Dupont

AU - Winther, Simon

AU - Eftekhari, Ashkan

AU - Karim, Salma Raghad

AU - Westra, Jelmer

AU - Isaksen, Christin

AU - Brix, Lau

AU - Ejlersen, June Anita

AU - Murphy, Theodore

AU - Milidonis, Xenios

AU - Nyegaard, Mette

AU - Benovoy, Mitchel

AU - Johansen, Jane Kirk

AU - Søndergaard, Hanne Maare

AU - Hammid, Osama

AU - Mortensen, Jesper

AU - Knudsen, Lars Lyhne

AU - Gormsen, Lars Christian

AU - Christiansen, Evald Høj

AU - Chiribiri, Amedeo

AU - Petersen, Steffen E.

AU - Böttcher, Morten

PY - 2023/5

Y1 - 2023/5

N2 - Background: Guidelines recommend verification of myocardial ischemia by selective second-line myocardial perfusion imaging (MPI) following a coronary computed tomography angiography (CTA) with suspected obstructive coronary artery disease (CAD). Head-to-head data on the diagnostic performance of different MPI modalities in this setting are sparse. Objectives: The authors sought to compare, head-to-head, the diagnostic performance of selective MPI by 3.0-T cardiac magnetic resonance (CMR) and 82rubidium positron emission tomography (RbPET) in patients with suspected obstructive stenosis at coronary CTA using invasive coronary angiography (ICA) with fractional flow reserve (FFR) as reference. Methods: Consecutive patients (n = 1,732, mean age: 59.1 ± 9.5 years, 57.2% men) referred for coronary CTA with symptoms suggestive of obstructive CAD were included. Patients with suspected stenosis were referred for both CMR and RbPET and subsequently ICA. Obstructive CAD was defined as FFR ≤0.80 or >90% diameter stenosis by visual assessment. Results: In total, 445 patients had suspected stenosis on coronary CTA. Of these, 372 patients completed both CMR, RbPET and subsequent ICA with FFR. Hemodynamically obstructive CAD was identified in 164 of 372 (44.1%) patients. Sensitivities for CMR and RbPET were 59% (95% CI: 51%-67%) and 64% (95% CI: 56%-71%); P = 0.21, respectively, and specificities 84% (95% CI: 78%-89%) and 89% (95% CI: 84%-93%]); P = 0.08, respectively. Overall accuracy was higher for RbPET compared with CMR (73% vs 78%; P = 0.03). Conclusions: In patients with suspected obstructive stenosis at coronary CTA, CMR, and RbPET show similar and moderate sensitivities but high specificities compared with ICA with FFR. This patient group represents a diagnostic challenge with frequent mismatch between advanced MPI tests and invasive measurements.

AB - Background: Guidelines recommend verification of myocardial ischemia by selective second-line myocardial perfusion imaging (MPI) following a coronary computed tomography angiography (CTA) with suspected obstructive coronary artery disease (CAD). Head-to-head data on the diagnostic performance of different MPI modalities in this setting are sparse. Objectives: The authors sought to compare, head-to-head, the diagnostic performance of selective MPI by 3.0-T cardiac magnetic resonance (CMR) and 82rubidium positron emission tomography (RbPET) in patients with suspected obstructive stenosis at coronary CTA using invasive coronary angiography (ICA) with fractional flow reserve (FFR) as reference. Methods: Consecutive patients (n = 1,732, mean age: 59.1 ± 9.5 years, 57.2% men) referred for coronary CTA with symptoms suggestive of obstructive CAD were included. Patients with suspected stenosis were referred for both CMR and RbPET and subsequently ICA. Obstructive CAD was defined as FFR ≤0.80 or >90% diameter stenosis by visual assessment. Results: In total, 445 patients had suspected stenosis on coronary CTA. Of these, 372 patients completed both CMR, RbPET and subsequent ICA with FFR. Hemodynamically obstructive CAD was identified in 164 of 372 (44.1%) patients. Sensitivities for CMR and RbPET were 59% (95% CI: 51%-67%) and 64% (95% CI: 56%-71%); P = 0.21, respectively, and specificities 84% (95% CI: 78%-89%) and 89% (95% CI: 84%-93%]); P = 0.08, respectively. Overall accuracy was higher for RbPET compared with CMR (73% vs 78%; P = 0.03). Conclusions: In patients with suspected obstructive stenosis at coronary CTA, CMR, and RbPET show similar and moderate sensitivities but high specificities compared with ICA with FFR. This patient group represents a diagnostic challenge with frequent mismatch between advanced MPI tests and invasive measurements.

KW - cardiac magnetic resonance

KW - chronic coronary syndrome

KW - coronary artery disease

KW - fractional flow reserve

KW - myocardial perfusion imaging

KW - positron emission tomography

UR - http://www.scopus.com/inward/record.url?scp=85152881623&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2022.11.015

DO - 10.1016/j.jcmg.2022.11.015

M3 - Journal article

C2 - 36881421

SN - 1936-878X

VL - 16

SP - 642

EP - 655

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 5

ER -

Second-Line Myocardial Perfusion Imaging to Detect Obstructive Stenosis: Head-to-Head Comparison of CMR and PET

Abstract

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