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Functional stress imaging to predict abnormal coronary fractional flow reserve: the PACIFIC 2 study.

Authors :
Driessen RS
van Diemen PA
Raijmakers PG
Knuuti J
Maaniitty T
Underwood SR
Nagel E
Robbers LFHJ
Demirkiran A
von Bartheld MB
van de Ven PM
Hofstra L
Somsen GA
Tulevski II
Boellaard R
van Rossum AC
Danad I
Knaapen P
Source :
European heart journal [Eur Heart J] 2022 Sep 01; Vol. 43 (33), pp. 3118-3128.
Publication Year :
2022

Abstract

Aims: The diagnostic performance of non-invasive imaging in patients with prior coronary artery disease (CAD) has not been tested in prospective head-to-head comparative studies. The aim of this study was to compare the diagnostic performance of qualitative single-photon emission computed tomography (SPECT), quantitative positron emission tomography (PET), and qualitative magnetic resonance imaging (MRI) in patients with a prior myocardial infarction (MI) or percutaneous coronary intervention (PCI).<br />Methods and Results: In this prospective clinical study, all patients with prior MI and/or PCI and new symptoms of ischaemic CAD underwent 99mTc-tetrofosmin SPECT, [15O]H2O PET, and MRI, followed by invasive coronary angiography with fractional flow reserve (FFR) in all coronary arteries. All modalities were interpreted by core laboratories. Haemodynamically significant CAD was defined by at least one coronary artery with an FFR ≤0.80. Among the 189 enrolled patients, 63% had significant CAD. Sensitivity was 67% (95% confidence interval 58-76%) for SPECT, 81% (72-87%) for PET, and 66% (56-75%) for MRI. Specificity was 61% (48-72%) for SPECT, 65% (53-76%) for PET, and 62% (49-74%) for MRI. Sensitivity of PET was higher than SPECT (P = 0.016) and MRI (P = 0.014), whereas specificity did not differ among the modalities. Diagnostic accuracy for PET (75%, 68-81%) did not statistically differ from SPECT (65%, 58-72%, P = 0.03) and MRI (64%, 57-72%, P = 0.052). Using FFR < 0.75 as a reference, accuracies increased to 69% (SPECT), 79% (PET), and 71% (MRI).<br />Conclusion: In this prospective head-to-head comparative study, SPECT, PET, and MRI did not show a significantly different accuracy for diagnosing FFR defined significant CAD in patients with prior PCI and/or MI. Overall diagnostic performances, however, were discouraging and the additive value of non-invasive imaging in this high-risk population is questionable.<br />Competing Interests: Conflict of interest: J.K. received consultancy fees from GE Healthcare and AstraZeneca and speaker fees from GE Healthcare, Bayer, Lundbeck, and Merck. P.K. received research grants from HeartFlow Inc. All other others have no conflict of interests to disclose.<br /> (© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.)

Details

Language :
English
ISSN :
1522-9645
Volume :
43
Issue :
33
Database :
MEDLINE
Journal :
European heart journal
Publication Type :
Academic Journal
Accession number :
35708168
Full Text :
https://doi.org/10.1093/eurheartj/ehac286