Multicentre multi-device hybrid imaging study of coronary artery disease: results from the EValuation of INtegrated Cardiac Imaging for the Detection and Characterization of Ischaemic Heart Disease (EVINCI) hybrid imaging population

Abstract

In patients at intermediate risk of CAD, hybrid imaging allows non-invasive co-localization of myocardial perfusion defects and subtending coronary arteries, impacting clinical decision-making in almost one every five subjects.

Myocardial ischemia without obstructive CAD: there is more than meets the eye!

“…15,16 The use of CCTA would have also favored the precise assignment of any myocardial perfusion abnormality to the pertinent coronary artery through hybrid cardiac imaging, allowing a proper per-vessel analysis of the coronary perfusion data. 12 Nevertheless, the present data underscore the relevance of endothelial dysfunction, possibly not limited to epicardial coronary vessels, over pure microvascular abnormalities in causing myocardial ischemia and angina. 23,24 Previous studies have demonstrated the functional inter-relationship between the distinct coronary anatomic compartments-conductive arteries, prearterioles, and arterioles-in determining coronary blood flow abnormalities in cardiac patients.…”

“…11 Possible integration with coronary computed tomography angiography (CCTA) allows to couple regional myocardial perfusion with underlying individual coronary anatomy. 12 Alteration of myocardial perfusion due to isolated coronary microvascular dysfunction can be documented non-invasively, after exclusion of coronary atherosclerosis, but is a relatively rare condition, limited almost entirely to pathologies characterized by the primitive adverse remodeling and fibrosis of intramural coronary arterioles, such as in the case of primary and secondary cardiomyopathies (i.e., hypertrophic cardiomyopathy, arterial hypertension, aortic stenosis). 5 More frequently, abnormal myocardial perfusion may express a regional or global impairment of coronary vasodilating capability, involving both epicardial and microvascular coronary vessels, associated with cardiovascular risk factors 5,13 or dilated cardiomyopathy.…”

Hybrid quantitative imaging: Will it enter clinical practice?

“…This benefit has been shown for both the analysis of relative MPI defects and for the quantitative absolute blood flow analysis by PET. The majority of recent studies of hybrid CTA and MPI, including recent large multicenter study, 1 did not utilize automatic fusion process, potentially increasing the review time and introducing additional subjectivity to the final interpretation. Nevertheless, the spatial registration of CTA with PET 2 or SPECT 3 can be fully automated, even if these datasets are obtained on separate scanners, relieving the operator from tedious and subjective alignment process.…”

Infarct characterization using CT

“…In the next years, image fusion and hybrid scanners will combine more effectively structural and functional information regarding the pathological sequence that goes from stenosis to ischemia (74)(75)(76)(77)(78).…”