Prognostic impact of location and extent of vessel-related ischemia at myocardial perfusion scintigraphy in patients with or at risk for coronary artery disease

Abstract

Location and extent of myocardial ischemia at MPS according to the VRI concept have a hierarchical predictive impact, with multi-VRI involving LAD being significantly and independently more prognostically ominous than other types of VRI.

Hybrid anatomo-functional imaging of coronary artery disease: Beneficial irrespective of its core components

“…Notwithstanding these subtleties, nuclear cardiology has been historically and continues to be the most robust and used non-invasive imaging modality for CAD, with SPECT largely toppling PET at least in terms of volume of procedures. 16,17 Advantages of nuclear imaging include the possibility of using exercise as stressor and the accrual of several diagnostic features such as myocardial perfusion, viability, geometry (e.g., stress and rest end-diastolic diameter), regional wall motion (after stress and at rest), and global systolic function (ejection fraction and end-systolic volume, and contractile reserve). [16][17][18][19][20] The advent of Alcyone technology-based solid-state cadmium-zinc-telluride (CZT) detectors, thanks to heightened spatial and energy resolution, increases sensitivity and specificity as well as acquisition time (\ 3 minutes) and effective radiation dose (\ 3 mSv).…”

Cadmium-zinc-telluride myocardial perfusion imaging: The dream of a single test gets nearer

“…[1][2][3] Myocardial perfusion imaging (MPI) with singlephoton emission computed tomography (SPECT) embodies the key strengths of non-invasive functional cardiovascular tests, by combining the physiologic details provided by stress testing (exercise or pharmacologic) with accurate information on myocardial perfusion, viability, and contractility, thus justifying its historically prominent role in cardiovascular imaging. 1,[4][5][6] The traditional acquisition technology for SPECT is the Anger camera, which has good diagnostic and excellent prognostic accuracy, as demonstrated by several studies with large sample size, despite its evident limitations in terms of spatial and energy resolution, as well as acquisition times. 7 The recent introduction of the cadmium-zinc-telluride (CZT) cameras for SPECT has purportedly revolutionized MPI, thanks to their superior spatial and energy resolution.…”

Bridging the Atlantic gap in clinical guidelines for non-ST-elevation acute coronary syndromes

“…12 Myocardial perfusion imaging (MPI) remains a powerful test in NSTEACS for its ease, access, reliability, and thus may maintain a dominating role among the available cardiac imaging tests. 1,2,[13][14][15] Yet, virtually all institutions have no 24/7 access to MPI. In addition, in very high-and high-risk patients, MPI is not useful for diagnostic purposes or short-term prognosis as diagnosis is already quite established and accordingly the indication to invasive management.…”

“…4,7 For instance, CT-derived anatomic imaging, which provides for instance details on lesion location, plaque features, vessel remodeling, calcium score, and stenosis severity can be seamlessly combined with MPI-derived functional imaging, which yields several functional parameters provided by MPI, including, most recently, coronary flow reserve. 6,[13][14][15] Thus, hybrid imaging provides many important results which are complementarily associated with pre-test and stress features, enabling the best clustering of the patient into a low-risk group, or otherwise prompting expedited invasive assessment, or guiding postdischarge management and follow-up.…”