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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-03-2012 | Original Article

Downstream resource utilization following hybrid cardiac imaging with an integrated cadmium-zinc-telluride/64-slice CT device

Authors: Michael Fiechter, Jelena R. Ghadri, Mathias Wolfrum, Silke M. Kuest, Aju P. Pazhenkottil, Rene N. Nkoulou, Bernhard A. Herzog, Cathérine Gebhard, Tobias A. Fuchs, Oliver Gaemperli, Philipp A. Kaufmann

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2012

Abstract

Purpose

Low yield of invasive coronary angiography and unnecessary coronary interventions have been identified as key cost drivers in cardiology for evaluation of coronary artery disease (CAD). This has fuelled the search for noninvasive techniques providing comprehensive functional and anatomical information on coronary lesions. We have evaluated the impact of implementation of a novel hybrid cadmium-zinc-telluride (CZT)/64-slice CT camera into the daily clinical routine on downstream resource utilization.

Methods

Sixty-two patients with known or suspected CAD were referred for same-day single-session hybrid evaluation with CZT myocardial perfusion imaging (MPI) and coronary CT angiography (CCTA). Hybrid MPI/CCTA images from the integrated CZT/CT camera served for decision-making towards conservative versus invasive management. Based on the hybrid images patients were classified into those with and those without matched findings. Matched findings were defined as the combination of MPI defect with a stenosis by CCTA in the coronary artery subtending the respective territory. All patients with normal MPI and CCTA as well as those with isolated MPI or CCTA finding or combined but unmatched findings were categorized as “no match”.

Results

All 23 patients with a matched finding underwent invasive coronary angiography and 21 (91%) were revascularized. Of the 39 patients with no match, 5 (13%, p < 0.001 vs matched) underwent catheterization and 3 (8%, p < 0.001 vs matched) were revascularized.

Conclusion

Cardiac hybrid imaging in CAD evaluation has a profound impact on patient management and may contribute to optimal downstream resource utilization.

Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS), European Association for Percutaneous Cardiovascular Interventions (EAPCI), Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. Guidelines on myocardial revascularization. Eur Heart J 2010;31:2501–55.PubMedCrossRef

Gaemperli O, Husmann L, Schepis T, Koepfli P, Valenta I, Jenni W, et al. Coronary CT angiography and myocardial perfusion imaging to detect flow-limiting stenoses: a potential gatekeeper for coronary revascularization? Eur Heart J 2009;30:2921–9.PubMedCrossRef

Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med 2010;362:886–95.PubMedCrossRef

Namdar M, Hany TF, Koepfli P, Siegrist PT, Burger C, Wyss CA, et al. Integrated PET/CT for the assessment of coronary artery disease: a feasibility study. J Nucl Med 2005;46:930–5.PubMed

Pazhenkottil AP, Buechel RR, Herzog BA, Nkoulou RN, Valenta I, Fehlmann U, et al. Ultrafast assessment of left ventricular dyssynchrony from nuclear myocardial perfusion imaging on a new high-speed gamma camera. Eur J Nucl Med Mol Imaging 2010;37:2086–92.PubMedCrossRef

Buechel RR, Herzog BA, Husmann L, Burger IA, Pazhenkottil AP, Treyer V, et al. Ultrafast nuclear myocardial perfusion imaging on a new gamma camera with semiconductor detector technique: first clinical validation. Eur J Nucl Med Mol Imaging 2010;37:773–8.PubMedCrossRef

Fiechter M, Ghadri JR, Kuest SM, Pazhenkottil AP, Wolfrum M, Nkoulou RN, et al. Nuclear myocardial perfusion imaging with a novel cadmium-zinc-telluride detector SPECT/CT device: first validation versus invasive coronary angiography. Eur J Nucl Med Mol Imaging 2011;38:2025–30.PubMedCrossRef

Buechel RR, Pazhenkottil AP, Herzog BA, Husmann L, Nkoulou RN, Burger IA, et al. Real-time breath-hold triggering of myocardial perfusion imaging with a novel cadmium-zinc-telluride detector gamma camera. Eur J Nucl Med Mol Imaging 2010;37:1903–8.PubMedCrossRef

Herzog BA, Buechel RR, Katz R, Brueckner M, Husmann L, Burger IA, et al. Nuclear myocardial perfusion imaging with a cadmium-zinc-telluride detector technique: optimized protocol for scan time reduction. J Nucl Med 2010;51:46–51.PubMedCrossRef

10.

Herzog BA, Buechel RR, Husmann L, Pazhenkottil AP, Burger IA, Wolfrum M, et al. Validation of CT attenuation correction for high-speed myocardial perfusion imaging using a novel cadmium-zinc-telluride detector technique. J Nucl Med 2010;51:1539–44.PubMedCrossRef

11.

Kajander S, Joutsiniemi E, Saraste M, Pietilä M, Ukkonen H, Saraste A, et al. Cardiac positron emission tomography/computed tomography imaging accurately detects anatomically and functionally significant coronary artery disease. Circulation 2010;122:603–13.PubMedCrossRef

12.

Pazhenkottil AP, Nkoulou RN, Ghadri JR, Herzog BA, Buechel RR, Küest SM, et al. Prognostic value of cardiac hybrid imaging integrating single-photon emission computed tomography with coronary computed tomography angiography. Eur Heart J 2011;32:1465–71.PubMedCrossRef

13.

Hesse B, Tagil K, Cuocolo A, Anagnostopoulos C, Bardiés M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 2005;32:855–97.PubMedCrossRef

14.

Giorgetti A, Rossi M, Stanislao M, Valle G, Bertolaccini P, Maneschi A, et al. Feasibility and diagnostic accuracy of a gated SPECT early-imaging protocol: a multicenter study of the Myoview Imaging Optimization Group. J Nucl Med 2007;48:1670–5.PubMedCrossRef

15.

Schepis T, Gaemperli O, Koepfli P, Rüegg C, Burger C, Leschka S, et al. Use of coronary calcium score scans from stand-alone multislice computed tomography for attenuation correction of myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging 2007;34:11–9.PubMedCrossRef

16.

Husmann L, Valenta I, Gaemperli O, Adda O, Treyer V, Wyss CA, et al. Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating. Eur Heart J 2008;29:191–7.PubMedCrossRef

17.

Herzog BA, Husmann L, Burkhard N, Gaemperli O, Valenta I, Tatsugami F, et al. Accuracy of low-dose computed tomography coronary angiography using prospective electrocardiogram-triggering: first clinical experience. Eur Heart J 2008;29:3037–42.PubMedCrossRef

18.

Buechel RR, Husmann L, Herzog BA, Pazhenkottil AP, Nkoulou R, Ghadri JR, et al. Low-dose computed tomography coronary angiography with prospective electrocardiogram triggering: feasibility in a large population. J Am Coll Cardiol 2011;57:332–6.PubMedCrossRef

19.

Gaemperli O, Schepis T, Kalff V, Namdar M, Valenta I, Stefani L, et al. Validation of a new cardiac image fusion software for three-dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography. Eur J Nucl Med Mol Imaging 2007;34:1097–106.PubMedCrossRef

20.

Gaemperli O, Schepis T, Valenta I, Husmann L, Scheffel H, Duerst V, et al. Cardiac image fusion from stand-alone SPECT and CT: clinical experience. J Nucl Med 2007;48:696–703.PubMedCrossRef

21.

Herzog BA, Husmann L, Buechel RR, Pazhenkottil AP, Burger IA, Valenta I, et al. Rapid cardiac hybrid imaging with minimized radiation dose for accurate non-invasive assessment of ischemic coronary artery disease. Int J Cardiol 2011;153:10–3. doi:10.1016/j.ijcard.2010.08.023.

22.

Tonino PA, Fearon WF, De Bruyne B, Oldroyd KG, Leesar MA. Ver Lee PN, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol 2010;55:2816–21.PubMedCrossRef

23.

Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’ t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009;360:213–24.PubMedCrossRef

24.

Ghadri JR, Pazhenkottil AP, Nkoulou RN, Goetti R, Buechel RR, Husmann L, et al. Very high coronary calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI. Heart 2011;97:998–1003.PubMedCrossRef

25.

van Buuren F, Horstkotte D. 24th report of performance statistics of heart catheterization laboratories in Germany. Der Kardiologe 2009;3:512–18.

26.

West R, Ellis G, Brooks N, Joint Audit Committee of the British Cardiac Society and Royal College of Physicians of London. Complications of diagnostic cardiac catheterisation: results from a confidential inquiry into cardiac catheter complications. Heart 2006;92:810–4.PubMedCrossRef

27.

Shaw LJ, Shaw RE, Merz CN, Brindis RG, Klein LW, Nallamothu B, et al. Impact of ethnicity and gender differences on angiographic coronary artery disease prevalence and in-hospital mortality in the American College of Cardiology-National Cardiovascular Data Registry. Circulation 2008;117:1787–801.PubMedCrossRef

28.

Kern MJ, Lerman A, Bech JW, De Bruyne B, Eeckhout E, Fearon WF, et al. Physiological assessment of coronary artery disease in the cardiac catheterization laboratory: a scientific statement from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology. Circulation 2006;114:1321–41.PubMedCrossRef

29.

Pazhenkottil A, Nkoulou R, Ghadri J, Herzog B, Küest S, Husmann L, et al. Impact of cardiac hybrid SPECT/CT imaging on choice of treatment strategy in coronary artery disease. Eur Heart J 2011;32:2824–9.

30.

Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356:1503–16.PubMedCrossRef

31.

Bucher HC, Hengstler P, Schindler C, Guyatt GH. Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials. BMJ 2000;321:73–7.PubMedCrossRef

32.

Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 1994;344:563–70.PubMedCrossRef

33.

Pitt B, Waters D, Brown WV, van Boven AJ, Schwartz L, Title LM, et al. Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. Atorvastatin versus Revascularization Treatment Investigators. N Engl J Med 1999;341:70–6.PubMedCrossRef

34.

Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 2008;117:1283–91.PubMedCrossRef

35.

Husmann L, Herzog BA, Gaemperli O, Tatsugami F, Burkhard N, Valenta I, et al. Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating. Eur Heart J 2009;30:600–7.PubMedCrossRef

36.

Nkoulou RN, Pazhenkottil AP, Kuest SM, Ghadri JR, Wolfrum M, Husmann L, et al. Semiconductor detectors allow low-dose-low-dose 1-day SPECT myocardial perfusion imaging. J Nucl Med 2011;52:1204–9.PubMedCrossRef

Title: Downstream resource utilization following hybrid cardiac imaging with an integrated cadmium-zinc-telluride/64-slice CT device
Authors: Michael Fiechter
Jelena R. Ghadri
Mathias Wolfrum
Silke M. Kuest
Aju P. Pazhenkottil
Rene N. Nkoulou
Bernhard A. Herzog
Cathérine Gebhard
Tobias A. Fuchs
Oliver Gaemperli
Philipp A. Kaufmann
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2012
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-011-1999-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Downstream resource utilization following hybrid cardiac imaging with an integrated cadmium-zinc-telluride/64-slice CT device

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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