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Jukema RA, Dahdal J, Kooijman EM, Wahedi E, de Winter RW, Guglielmo M, Cramer MJ, van der Harst P, Remmelzwaal S, Raijmakers P, Knaapen P, Danad I. Diagnostic accuracy of non-invasive cardiac imaging modalities in patients with a history of coronary artery disease: a meta-analysis. Heart 2024:heartjnl-2024-324248. [PMID: 39179368 DOI: 10.1136/heartjnl-2024-324248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 08/03/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND The diagnostic performance of non-invasive imaging techniques for detecting obstructive coronary artery disease (CAD) in patients with a history of myocardial infarction or percutaneous coronary intervention has not been comprehensively evaluated. This meta-analysis assesses the diagnostic value of coronary CT angiography (CCTA), CCTA combined with CT perfusion (CCTA+CTP), cardiac MRI (CMR) and single-photon emission CT (SPECT) compared with invasive reference standards. METHODS We systematically searched PubMed, Embase, Web of Science and the Cochrane Library from 2005 to September 2022 for prospective, blinded studies including populations with ≥50% prior CAD. RESULTS We identified 18 studies encompassing 3265 patients, with obstructive CAD present in 64%. The per-patient sensitivity of CCTA (0.95; 95% CI 0.92 to 0.98), CCTA+CTP (0.93; 95% CI 0.84 to 0.98) and CMR (0.91; 95% CI 0.86 to 0.94) was high, while SPECT showed lower sensitivity (0.63; 95% CI 0.52 to 0.73). SPECT had higher specificity compared with CCTA (0.66; 95% CI 0.56 to 0.76 vs 0.37; 95% CI 0.29 to 0.46), but was comparable to CCTA+CTP (0.59; 95% CI 0.49 to 0.69) and CMR (0.69; 95% CI 0.53 to 0.81). The area under the curve for SPECT was the lowest (0.70; 95% CI 0.58 to 0.87), while CCTA (0.91; 95% CI 0.86 to 0.98), CCTA+CTP (0.89; 95% CI 0.73 to 1.00) and CMR (0.91; 95% CI 0.80 to 1.00) showed similar high values. CONCLUSIONS In patients with prior CAD, CCTA, CCTA+CTP and CMR demonstrated high diagnostic performance, whereas SPECT had lower sensitivity. These findings can guide the selection of non-invasive imaging techniques in this high-risk population. PROSPERO REGISTRATION NUMBER CRD42022322348.
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Affiliation(s)
- Ruurt A Jukema
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jorge Dahdal
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medicine, Hospital del Salvador, Santiago, Chile
| | - Eline M Kooijman
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ellaha Wahedi
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruben W de Winter
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marco Guglielmo
- Division of Heart and Lungs, Department of Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Maarten Jan Cramer
- Division of Heart and Lungs, Department of Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Pim van der Harst
- Division of Heart and Lungs, Department of Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Sharon Remmelzwaal
- Epidemiology and Biostatistics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Pieter Raijmakers
- Department of Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Division of Heart and Lungs, Department of Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
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Dahdal J, Jukema RA, Harms HJ, Cramer MJ, Raijmakers PG, Knaapen P, Danad I. PET myocardial perfusion imaging: Trends, challenges, and opportunities. J Nucl Cardiol 2024:102011. [PMID: 39067504 DOI: 10.1016/j.nuclcard.2024.102011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/25/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024]
Abstract
Various non-invasive images are used in clinical practice for the diagnosis and prognostication of chronic coronary syndromes. Notably, quantitative myocardial perfusion imaging (MPI) through positron emission tomography (PET) has seen significant technical advancements and a substantial increase in its use over the past two decades. This progress has generated an unprecedented wealth of clinical information, which, when properly applied, can diagnose and fine-tune the management of patients with different types of ischemic syndromes. This state-of-art review focuses on quantitative PET MPI, its integration into clinical practice, and how it holds up at the eyes of modern cardiac imaging and revascularization clinical trials, along with future perspectives.
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Affiliation(s)
- Jorge Dahdal
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Hospital Del Salvador, Santiago, Chile
| | - Ruurt A Jukema
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter G Raijmakers
- Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Paul Knaapen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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Danad I, Driessen RS. Utility of 82Rb and [ 15O]H 2O PET myocardial perfusion imaging in challenging (high risk) patients: "Don't throw the baby out with the bathwater". J Nucl Cardiol 2024; 32:101783. [PMID: 38233322 DOI: 10.1016/j.nuclcard.2023.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Ibrahim Danad
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Roel S Driessen
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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