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Ora M, Gambhir S. Myocardial Perfusion Imaging: A Brief Review of Nuclear and Nonnuclear Techniques and Comparative Evaluation of Recent Advances. Indian J Nucl Med 2019; 34:263-270. [PMID: 31579355 PMCID: PMC6771197 DOI: 10.4103/ijnm.ijnm_90_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide. Invasive coronary angiography (ICA) is the gold standard for the evaluation of epicardial CAD. In the pathogenesis of the CAD, myocardial perfusion abnormalities are the first changes that appear followed by wall motion abnormalities, electrocardiogram changes, and angina. Myocardial perfusion imaging (MPI) demonstrates the cumulative effect of pathology at epicardial coronary arteries, small vessels, and endothelium. Thus, it evaluates the overall burden of ischemic heart disease (IHD). MPI is used noninvasively to diagnose early asymptomatic CAD or to know the functional significance of known CAD. There are evidence that early detection of myocardial perfusion abnormalities followed by aggressive intervention against cardiovascular risk factors may restore myocardial perfusion. This may lead to reduce morbidity and mortality. Various MPI modalities have been used to diagnose and define the severity of CAD. Cardiac myocardial perfusion single-photon emission computed tomography (myocardial perfusion scintigraphy [MPS]) has been in use since decades. Several newer modalities such as positron emission tomography, cardiac magnetic resonance imaging, computed tomography perfusion, and myocardial contrast echocardiography are developing utilizing the similar principle of MPS. We shall be reviewing briefly these modalities, their performance, comparison to each other, and with ICA.
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Affiliation(s)
- Manish Ora
- Professor and Head of the Department, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Sanjay Gambhir
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
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van Waardhuizen CN, Khanji MY, Genders TS, Ferket BS, Fleischmann KE, Hunink MM, Petersen SE. Comparative cost-effectiveness of non-invasive imaging tests in patients presenting with chronic stable chest pain with suspected coronary artery disease: a systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:245-260. [DOI: 10.1093/ehjqcco/qcw029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/27/2016] [Indexed: 02/05/2023]
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3
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Cardiac risk factors and risk scores vs cardiac computed tomography angiography: a prospective cohort study for triage of ED patients with acute chest pain. Am J Emerg Med 2013; 31:1479-85. [DOI: 10.1016/j.ajem.2013.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/22/2013] [Accepted: 08/03/2013] [Indexed: 11/19/2022] Open
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Borges Santos M, Ferreira AM, de Araújo Goncalves P, Raposo L, Campante Teles R, Almeida M, Mendes M. Diagnostic yield of current referral strategies for elective coronary angiography in suspected coronary artery disease—An analysis of the ACROSS registry. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Borges Santos M, Ferreira AM, Araújo Gonçalves PD, Raposo L, Campante Teles R, Almeida M, Mendes M. Diagnostic yield of current referral strategies for elective coronary angiography in suspected coronary artery disease—An analysis of the ACROSS registry. Rev Port Cardiol 2013; 32:483-8. [DOI: 10.1016/j.repc.2012.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 11/01/2012] [Indexed: 10/26/2022] Open
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McBride CB, Cheezum MK, Gore RS, Pathirana IN, Slim AM, Villines TC. Coronary Artery Calcium Testing in Symptomatic Patients: An Issue of Diagnostic Efficiency. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013; 6:211-220. [PMID: 23795234 PMCID: PMC3683145 DOI: 10.1007/s12410-013-9198-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The detection and quantification of coronary artery calcification (CAC) significantly improves cardiovascular risk prediction in asymptomatic patients. Many have advocated for expanded CAC testing in symptomatic patients based on data demonstrating that the absence of quantifiable CAC in patients with possible angina makes obstructive coronary artery disease (CAD) and subsequent adverse events highly unlikely. However, the widespread use of CAC testing in symptomatic patients may be limited by the high background prevalence of CAC and its low specificity for obstructive CAD, necessitating additional testing ('test layering') in a large percentage of eligible patients. Further, adequately powered prospective studies validating the comparative effectiveness of a 'CAC first' approach with regards to cost, safety, accuracy and clinical outcomes are lacking. Due to marked reductions in patient radiation exposure and higher comparative accuracy and prognostic value make coronary computed tomographic angiography the preferred CT-based test for appropriately selected symptomatic patients.
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Affiliation(s)
- Chad B McBride
- Cardiology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue., Bethesda, MD 20850 USA
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Whelton SP, Nasir K, Blaha MJ, Gransar H, Metkus TS, Coresh J, Berman DS, Blumenthal RS. Coronary artery calcium and primary prevention risk assessment: what is the evidence? An updated meta-analysis on patient and physician behavior. Circ Cardiovasc Qual Outcomes 2012; 5:601-7. [PMID: 22811506 DOI: 10.1161/circoutcomes.112.965566] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Seamus P Whelton
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA.
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012. [PMID: 23182125 DOI: 10.1016/j.jacc.2012.07.013] [Citation(s) in RCA: 1231] [Impact Index Per Article: 102.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012; 126:e354-471. [PMID: 23166211 DOI: 10.1161/cir.0b013e318277d6a0] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Chinnaiyan KM, Raff GL, Goraya T, Ananthasubramaniam K, Gallagher MJ, Abidov A, Boura JA, Share D, Peyser PA. Coronary Computed Tomography Angiography After Stress Testing. J Am Coll Cardiol 2012; 59:688-95. [DOI: 10.1016/j.jacc.2011.10.886] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 10/11/2011] [Accepted: 10/27/2011] [Indexed: 12/13/2022]
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Current world literature. Curr Opin Cardiol 2011; 26:457-61. [PMID: 21832895 DOI: 10.1097/hco.0b013e32834b1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Blaha MJ, Blumenthal RS, Budoff MJ, Nasir K. Understanding the utility of zero coronary calcium as a prognostic test: a Bayesian approach. Circ Cardiovasc Qual Outcomes 2011; 4:253-6. [PMID: 21406674 DOI: 10.1161/circoutcomes.110.958496] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Michael J Blaha
- Division of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA.
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Cheaper, better, or good enough: Evidentiary standards for coronary CTA. J Cardiovasc Comput Tomogr 2011; 5:110-2. [DOI: 10.1016/j.jcct.2011.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 03/01/2011] [Indexed: 11/18/2022]
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Halpern EJ. Clinical applications of cardiac CT angiography. Insights Imaging 2010; 1:205-222. [PMID: 22347917 PMCID: PMC3259381 DOI: 10.1007/s13244-010-0038-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 07/22/2010] [Accepted: 07/29/2010] [Indexed: 01/07/2023] Open
Abstract
ECG-gated multislice CT provides a cost-effective, non-invasive technology for evaluation of the coronary arteries, as well as for additional clinical applications, which require morphological assessment of the heart and adjacent structures with simultaneous evaluation of the coronary circulation.The excellent negative predictive value of a normal coronary CTA (cCTA) examination excludes the presence of significant coronary disease in the symptomatic patient. Triple rule-out studies provide evaluation of the aorta and pulmonary arteries without loss of image quality in the coronary circulation. The ability to visualize surrounding vascular structures along with the coronary arteries is essential in the evaluation of coronary anomalies.Cardiac CTA is useful in non-coronary applications, including evaluation of the thoracic aorta, cardiac valves and other aspects of cardiac morphology that may require surgical or percutaneous repair. Although radiation exposure is a limitation of cCTA relative to echocardiography and MRI, recent technological advances allow coronary imaging with effective doses as low as 1 mSv.Recent advances in evaluation of coronary plaque morphology as well as myocardial perfusion will allow a more complete noninvasive cardiac assessment in the future and may provide a highly effective method of cardiac risk stratification to facilitate preventive cardiac care.
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Affiliation(s)
- Ethan J. Halpern
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA 19107-5244 USA
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Halpern EJ. Toward a standardized training curriculum in cardiac imaging. Acad Radiol 2010; 17:679-80. [PMID: 20457411 DOI: 10.1016/j.acra.2010.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 03/11/2010] [Accepted: 03/11/2010] [Indexed: 11/18/2022]
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