title: Prognostic value of cardiac hybrid imaging integrating single-photon emission computed tomography with coronary computed tomography angiography.
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.
authors.affiliation: Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland. pak@usz.ch
authors.forename: Aju P
authors.initials: AP
authors.lastname: Pazhenkottil
authors.forename: René N
authors.initials: RN
authors.lastname: Nkoulou
authors.forename: Jelena-Rima
authors.initials: JR
authors.lastname: Ghadri
authors.forename: Bernhard A
authors.initials: BA
authors.lastname: Herzog
authors.forename: Ronny R
authors.initials: RR
authors.lastname: Buechel
authors.forename: Silke M
authors.initials: SM
authors.lastname: Küest
authors.forename: Mathias
authors.initials: M
authors.lastname: Wolfrum
authors.forename: Michael
authors.initials: M
authors.lastname: Fiechter
authors.forename: Lars
authors.initials: L
authors.lastname: Husmann
authors.forename: Oliver
authors.initials: O
authors.lastname: Gaemperli
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000401:mortality; D002423:Cause of Death; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D009204:Myocardial Revascularization / Q000401:mortality; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011379:Prognosis; D011829:Radiation Dosage; D019275:Radiopharmaceuticals; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods* / Q000401:mortality; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000401:mortality
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin