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Three-dimensional Fusion of Myocardial Perfusion SPECT and Invasive Coronary Angiography Guides Coronary Revascularization

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

SPECT myocardial perfusion imaging (SPECT MPI) and invasive coronary angiography (ICA) provide complementary clinical information in the diagnosis of coronary artery disease (CAD). We have developed an approach for 3D fusion of perfusion data from SPECT MPI and coronary anatomy from ICA. In this study, we aimed to evaluate its clinical value when compared to the traditional side-by-side readings.

Methods

Thirty-six CAD patients who had at least one stenosis ≥ 50% were retrospectively enrolled. Based on the presence of a perfusion defect in a territory subtended by a coronary vessel, all vessels were classified as matched, unmatched, or normal groups via both the fusion and side-by-side analysis. The treatments recommended by the fusion and side-by-side analysis were compared with those that the patients received. Major adverse cardiac events (MACE), defined as all-cause death, myocardial infarction, unstable angina requiring hospitalization, and unplanned revascularization, were assessed.

Results

The overall vessel-based concordance was 78.7% between the fusion and side-by-side analysis. Compared with the side-by-side analysis, 23 coronary arteries (29 equivocal segments) of 19 patients were reclassified via fusion of data. In the matched, unmatched, and normal groups, the numbers of vessels with hemodynamically significant stenosis which caused reversible defect were 37 vs 53, 28 vs 14, and 43 vs 41 (P < .01) when comparing the side-by-side analysis with the fusion, and the revascularization ratios per vessel were 69% vs 88%, 29% vs 10%, and 2% vs 2% between them. During the five-year follow-up, 8 patients (22.2%) experienced MACE. Patients who received the same treatment as the guidance of 3D fusion results (n = 22) had superior outcomes when compared with those who did not (n = 14) (P < .01).

Conclusions

Compared with the side-by-side analysis, the 3D fusion of SPECT MPI and ICA provided incremental diagnostic and prognostic value.

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Abbreviations

CAD:

Coronary artery disease

ICA:

Invasive coronary angiography

LV:

Left ventricle

LCA:

Left coronary artery

LAD:

Left anterior descending

LCX:

Left circumflex artery

MPI:

Myocardial perfusion imaging

PCI:

Percutaneous coronary intervention

RCA:

Right coronary artery

SPECT:

Single-photon emission computed tomography

CCTA:

Coronary computed tomography angiography

FFR:

Fractional flow reserve

AI:

Artificial intelligence

MACE:

Major adverse cardiac events

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Acknowledgments

The authors have indicated they have no financial conflict of interest.

Author information

Author notes

  1. Zhihui Xu and Haipeng Tang contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital of Nan**g Medical University, 300 Guangzhou Rd, Gulou, Nan**g, 210000, China

    Zhihui Xu MD, Zekang Ye PhD, Ying Zhou PhD, Shun Xu PhD, Dianfu Li MD & Cheng Wang MD

  2. School of Computing Sciences and Computer Engineering, University of Southern Mississippi, Hattiesburg, MS, 39406, USA

    Haipeng Tang PhD

  3. Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, 60612, USA

    Saurabh Malhotra MD

  4. Division of Cardiology, Rush Medical College, Chicago, IL, 60612, USA

    Saurabh Malhotra MD

  5. School of Computer and Communication Engineering, Zhengzhou University of Light Industry, Zhengzhou, 450000, Henan, China

    Minghao Dong BS

  6. Department of Applied Computing, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA

    Chen Zhao MS & Weihua Zhou PhD

  7. Center for Biocomputing and Digital Health, Institute of Computing and Cybersystems, and Health Research Institute, Michigan Technological University, Houghton, MI, 49931, USA

    Weihua Zhou PhD

Authors
  1. Zhihui Xu MD
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Corresponding authors

Correspondence to Cheng Wang MD or Weihua Zhou PhD.

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Disclosures

None of the authors, including Zhihui Xu, Haipeng Tang, Saurabh Malhotra, Minghao Dong, Chen Zhao, Zekang Ye, Ying Zhou, Shun Xu, Dianfu Li, Cheng Wang and Weihua Zhou, has any relevant conflicts of interest.

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Funding

This research was supported by a new faculty grant from Michigan Technological University Institute of Computing and Cybersystems (PI: Weihua Zhou), a seed grant from Michigan Technological University Health Research Institute (PI: Weihua Zhou), and a grant from the National Nature Science Foundation of China (PI: Cheng Wang, 82100338).

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Xu, Z., Tang, H., Malhotra, S. et al. Three-dimensional Fusion of Myocardial Perfusion SPECT and Invasive Coronary Angiography Guides Coronary Revascularization. J. Nucl. Cardiol. 29, 3267–3277 (2022). https://doi.org/10.1007/s12350-022-02907-8

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