Imaging Highlights From the European Society of Cardiology, American Society of Nuclear Cardiology, and Heart Failure Society of America
Juhani Knuuti, MD, PhD*,
Don Poldermans, MD, PhD ,
James E. Udelson, MD ,
Frans J. Th. Wackers, MD, PhD, FACC ,
Jeroen J. Bax, MD, PhD, FACC||,1,*
* Turku PET Center, Turku, Finland
ThoraxCenter, Rotterdam, the Netherlands
Tufts–New England Medical Center, Boston, Massachusetts
Yale University School of Medicine, New Haven, Connecticut
|| Leiden University Medical Center, Leiden, the Netherlands.
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Figure 1 Kaplan-Meier Event-Free Survival Curves
Kaplan-Meier event-free survival curves of patients with normal coronary flow reserve (CFR) (>2) and reduced CFR. Data from Sicari et al. (1).
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Figure 2 Assessment of LV Dyssynchrony From 2-Dimensional Radial Strain Using Speckle Tracking
In the left panel, the 2-dimensional strain images are represented. The right panel shows the segmental time-strain curves for each region (the colors of the curves correspond to the colors of the regions on the short-axis slice in the left panel). Time differences in peak systolic strain (t) between anteroseptal (AS) and posterior (P) segments are measured and indicate the maximum dyssynchrony. Data from Delgado et al. (6).
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Figure 3 Accuracy of 2-Dimensional Radial Strain to Predict Response to Resynchronization Therapy
The receiver-operator characteristic curve analysis identified an optimal cutoff value to predict response to cardiac resynchronization therapy of 130 ms or more for left ventricular dyssynchrony reflected by an AS-to-P (AS-P) wall delay in 2-dimensional radial strain (RS). This cutoff value yielded a sensitivity of 83% with a specificity of 71%, with an area under the curve (AUC) of 0.75. Abbreviations as in Figure 2. Data from Delgado et al. (6).
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Figure 4 MRI, MDCT, and Invasive Coronary Angiography
Example of whole-heart MRI angiography (left), MDCT angiography (middle), and invasive angiography (right). Upper row = left coronary artery; lower row = right coronary artery. MDCT = multidetector computed tomography; MRI = magnetic resonance imaging. Data from Pouleur et al. (9).
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Figure 5 Dual-Source MDCT Study in a Patient With Severe Coronary Calcifications
Arrows denote the vessel segment with severe coronary calcifications (making interpretation difficult) but lumen narrowing on the invasive angiography. Abbreviations as in Figure 4. Data from Burgstahler et al. (11).
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Figure 6 Prognosis According to MDCT and SPECT Perfusion Imaging
Cardiac event rate (cardiac death, nonfatal infarction, unstable angina requiring hospitalization, and late revascularization) according to MDCT and SPECT data. MPI = myocardial perfusion imaging; SPECT = single-photon emission computed tomography; other abbreviations as in Figure 4. Data from Van Werkhoven et al. (13).
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Figure 7 Comparison of Image Quality of F18-BMS-747158-02 and N13-Ammonia Perfusion Studies in a Healthy Normal Pig
Image acquisition was performed sequentially on an LSO-positron emission tomography scanner (200 MBq NH3 first, 30-min delay, 100 MBq BMS second; 5-min post-injection; scan duration 5 min for both tracers). LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle. Data from Nekolla et al. (15).
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Figure 8 Reconstruction of SPECT Perfusion Data: WBR Versus FBP
Correlation of summed stress score (SSS) derived from images processed with conventional filtered back projection (FBP) acquired over 30 stops, 40 s/stop (total 20 min) and images processed with wide-beam reconstruction (WBR) technology acquired over 60 stops, 10 s/stop (total acquisition time 10 min). An excellent correlation is observed between these 2 techniques over a wide range of SSS. SPECT = single-photon emission computed tomography. Data from Pena et al. (17).
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Figure 9 Relationship Between Findings on 64-Slice CTA and Stress SPECT MPI on a Patient Basis
Of 44 patients without significant coronary artery stenoses on computed tomography coronary angiography (CTA), stress myocardial perfusion imaging (MPI) was normal in 91%. Of 15 patients with apparent significant stenoses ( 50%) on CTA, stress MPI was abnormal in 60%. SPECT = single-photon emission computed tomography. Data from Brooks et al. (21).
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Figure 10 Event-Free Survival Versus Soft Plaques on MDCT
Cumulative survival, free of acute coronary syndrome (ACS), in 810 patients with nonobstructive coronary artery disease on computed tomography angiography with (Group 1, n = 189) and without (Group 2, n = 621) low-density (<68 HU) coronary plaques. Abbreviations as in Figure 4. Data from Sato et al. (24).
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Figure 11 Two Representative Phase Histograms From Patients With Left Ventricular Ejection Fraction  35%
For each, the left panel is a polar map representing the phase values around the left ventricle, and the right panel is a histogram of phase values. (B) Histogram shows a higher level of dyssynchrony as evidenced by a broader and less peaked phase histogram than seen in panel A. Data from Trimble et al. (27).
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