Impact of rubidium imaging availability on management of patients with acute chest pain

[Cost-effectiveness of using rubidium-82 chloride perfusion PET for planning myocardial revascularization procedures]

OBJECTIVE

The aim of this study is to evaluate the cost-effectiveness, diagnostic accuracy, clinical outcomes, and radiation exposure associated with rubidium-82 chloride perfusion PET.

METHODS

A comprehensive literature search up to October 2024 was conducted to identify key studies assessing the use of rubidium-82 chloride perfusion PET/CT in ischemic heart disease (IHD). These studies included economic analyses, evaluations of diagnostic accuracy, and comparisons with other imaging modalities such as single-photon emission computed tomography (SPECT), stress echocardiography, and invasive coronary angiography.

RESULTS

The reviewed studies demonstrate that rubidium-82 chloride perfusion PET/CT has high sensitivity and specificity in detecting IHD (90% and 91%, respectively) accompanied by significant coronary artery stenosis. Economic analyses show that this method is cost-effective due to a reduction in the use of downstream invasive procedures, leading to overall cost savings. Additionally, the economic impact on healthcare is enhanced by a lower level of radiation exposure compared to traditional perfusion SPECT imaging, reducing associated future radiation risks. The cost-effectiveness and minimum patient throughput required for implementing this modality In Russia were evaluated.

CONCLUSION

The presented data confirm the cost-effectiveness of rubidium-82 chloride perfusion PET/CT by reducing costs for subsequent diagnostic and therapeutic interventions while maintaining a sufficient patient flow.

Critical Appraisal of the Current Role of Myocardial Perfusion Imaging in the Management of Acute Chest Pain

This paper describes the evolution of nuclear cardiology techniques in the setting of acute coronary syndromes. Since the 1970s, the contribution of nuclear cardiology has been fundamental in delineating the physiopathology and diagnosis of acute myocardial infarction, when electrocardiogram (ECG) did not provide the diagnosis and when cardiac enzyme assessments were at a very early stage. In this clinical situation, at that time the role of pyrophosphate scintigraphy and antimyosin antibodies was important in ensuring diagnostic precision. However, these methods showed limitations and were abandoned in the late 80s and early 90s when therapeutic applications such as thrombolytic therapy, and primary-and rescue-percutaneous coronary intervention (PCI) were introduced. Beginning in the mid-80s, the introduction and widespread use of perfusion tracers such as 99mTc labelled compounds and technological advances such as SPECT, allowed to assess the efficacy of thrombolysis and early revascularization, as well as to assess in depth myocardial salvage. Currently, perfusion SPECT, especially using fast imaging techniques and dedicated cardiac SPECT with solid-state detectors, allows a quick confirmation or exclusion of acute coronary syndromes, particularly in low-to-intermediate likelihood of coronary artery disease (CAD), especially when there are absolute or relative contraindications to the use of coronary computed tomographic angiography (CCTA).

Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2022: positron emission tomography, computed tomography, and magnetic resonance

In 2022, the Journal of Nuclear Cardiology® published many excellent original research articles and editorials focusing on imaging in patients with cardiovascular disease. In this review of 2022, we summarize a selection of articles to provide a concise recap of major advancements in the field. In the first part of this 2-part series, we addressed publications pertaining to single-photon emission computed tomography. In this second part, we focus on positron emission tomography, cardiac computed tomography, and cardiac magnetic resonance. We specifically review advances in imaging of non-ischemic cardiomyopathy, cardio-oncology, infectious disease cardiac manifestations, atrial fibrillation, detection and prognostication of atherosclerosis, and technical improvements in the field. We hope that this review will be useful to readers as a reminder to articles they have seen during the year as well as ones they have missed.