Author + information
- Received February 1, 2017
- Revision received May 23, 2017
- Accepted May 29, 2017
- Published online April 2, 2018.
- Asim Rizvi, MDa,b,
- Donghee Han, MDa,c,
- Ibrahim Danad, MDd,
- Bríain Ó Hartaigh, PhDa,
- Ji Hyun Lee, MDa,c,
- Heidi Gransar, MSce,
- Wijnand J. Stuijfzand, MDa,
- Hadi Mirhedayati Roudsari, MDa,
- Mahn Won Park, MDa,
- Jackie Szymonifka, MAa,
- Hyuk-Jae Chang, MD, PhDc,
- Erica C. Jones, MDa,
- Paul Knaapen, MDd,
- Fay Y. Lin, MDa,
- James K. Min, MDa and
- Jessica M. Peña, MD, MPHa,∗ ()
- aDalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
- bDepartment of Radiology, Mayo Clinic, Rochester, Minnesota
- cDivision of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
- dDepartment of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
- eDepartments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Jessica M. Peña, Weill Cornell Medicine and New York-Presbyterian Hospital, Dalio Institute of Cardiovascular Imaging, 413 East 69th Street, Suite 108, New York, New York 10021.
Objectives The current meta-analysis aimed to evaluate the diagnostic performance of hybrid cardiac imaging techniques compared with stand-alone coronary computed tomography angiography (CTA) for assessment of obstructive coronary artery disease (CAD).
Background The usefulness of coronary CTA for detecting obstructive CAD remains suboptimal at present. Myocardial perfusion imaging encompasses positron emission tomography, single-photon emission computed tomography, and cardiac magnetic resonance, which permit the identification of myocardial perfusion defects to detect significant CAD. A hybrid approach comprising myocardial perfusion imaging and coronary CTA may improve diagnostic performance for detecting obstructive CAD.
Methods PubMed and Web of Knowledge were searched for relevant publications between January 1, 2000 and December 31, 2015. Studies using coronary CTA and hybrid imaging for diagnosis of obstructive CAD (a luminal diameter reduction of >50% or >70% by invasive coronary angiography) were included. In total, 12 articles comprising 951 patients and 1,973 vessels were identified, and a meta-analysis was performed to determine pooled sensitivity, specificity, and summary receiver-operating characteristic curves.
Results On a per-patient basis, the pooled sensitivity of hybrid imaging was comparable to that of coronary CTA (91% vs. 90%; p = 0.28). However, specificity was higher for hybrid imaging versus coronary CTA (93% vs. 66%; p < 0.001). On a per-vessel basis, sensitivity for hybrid imaging against coronary CTA was comparable (84% vs. 89%; p = 0.29). Notably, hybrid imaging yielded a specificity of 95% versus 83% for coronary CTA (p < 0.001). Summary receiver-operating characteristic curves displayed improved discrimination for hybrid imaging beyond coronary CTA alone, on a per-vessel basis (area under the curve: 0.97 vs. 0.93; p = 0.047), although not on a per-patient level (area under the curve: 0.97 vs. 0.93; p = 0.132).
Conclusions Hybrid cardiac imaging demonstrated improved diagnostic specificity for detection of obstructive CAD compared with stand-alone coronary CTA, yet improvement in overall diagnostic performance was relatively limited.
This study was funded by National Institutes of Health grants R01 HL111141 and R01 HL118019; and was also supported in part by generous gifts from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Min serves on the advisory board of Arineta; has ownership in MDDX and Autoplaq; and has a research agreement with GE Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Drs. Rizvi and Han contributed equally to this work.
Matthew Budoff, MD, served as the Guest Editor for this paper.
- Received February 1, 2017.
- Revision received May 23, 2017.
- Accepted May 29, 2017.
- 2018 The Authors