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

AIMS: Hybrid imaging provides a non-invasive assessment of coronary anatomy and myocardial perfusion. We sought to evaluate the added clinical value of hybrid imaging in a multi-centre multi-vendor setting. METHODS AND RESULTS: Fourteen centres enrolled 252 patients with stable angina and intermediate (20-90%) pre-test likelihood of coronary artery disease (CAD) who underwent myocardial perfusion scintigraphy (MPS), CT coronary angiography (CTCA), and quantitative coronary angiography (QCA) with fractional flow reserve (FFR). Hybrid MPS/CTCA images were obtained by 3D image fusion. Blinded core-lab analyses were performed for CTCA, MPS, QCA and hybrid datasets. Hemodynamically significant CAD was ruled-in non-invasively in the presence of a matched finding (myocardial perfusion defect co-localized with stenosed coronary artery) and ruled-out with normal findings (both CTCA and MPS normal). Overall prevalence of significant CAD on QCA (>70% stenosis or 30-70% with FFR 640.80) was 37%. Of 1004 pathological myocardial segments on MPS, 246 (25%) were reclassified from their standard coronary distribution to another territory by hybrid imaging. In this respect, in 45/252 (18%) patients, hybrid imaging reassigned an entire perfusion defect to another coronary territory, changing the final diagnosis in 42% of the cases. Hybrid imaging allowed non-invasive CAD rule-out in 41%, and rule-in in 24% of patients, with a negative and positive predictive value of 88% and 87%, respectively. CONCLUSION: 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

MORT SUBITE RYTHMIQUE (A PROPOS DE 46 PATIENTS CONSECUTIFS)

PARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Développement de l'imagerie moléculaire du thrombus artériel

Le thrombus artériel, ou thrombus intra-luminal (ILT), est impliqué à des degrés divers dans la majorité des pathologies cardiovasculaires dégénératives. Actuellement, sa détection et sa caractérisation repose sur des techniques d'imagerie morphologique qui ne renseignent pas sur l'évolution possible du thrombus en relation avec son profil d'activités biologiques. Dans ce contexte, l'imagerie moléculaire du thrombus a 3 objectifs principaux : (1) la détection du thrombus initial et la recherche de localisations secondaires, (2) l'évaluation du potentiel évolutif du thrombus et de son impact sur les tissus environnants en relation avec son activité biologique, (3) l'évaluation précoce de l'efficacité thérapeutique (avant une modification morphologique). L'objectif de ce travail a été de développer des agents d'imagerie moléculaire des activités biologiques de l'ILT. En ce qui concerne l'activité proagrégante du thrombus artériel, nous avons mis en évidence le lien existant entre l'intensité du signal en Annexine A5 radiomarquée détecté in vivo et l'intensité de l'activité proagrégante dans un modèle d'endocardite infectieuse. Nous avons développé un nouveau traceur élaboré sur la base d'un ligand naturel et de haute affinité (le fucoïdan) de la P-sélectine exprimée par les plaquettes activées, puis validé sa capacité à détecter in vivo le thrombus artériel. En ce qui concerne l'activité plasminergique du thrombus artériel, nous avons utilisé l'aprotinine radiomarquée pour détecter la plasmine dans le thrombus anévrysmal humain ex vivo, puis entamé une collaboration pour optimiser son radiomarquage en utilisant un tag peptidique sans cystéine en position N-terminale. Parallèlement nous avons développé une nouvelle approche basée sur un inhibiteur peptidique conjugué à un agent chélateur bifonctionnelArteriel or intra-luminal thrombus (ILT) is involved to various degrees in most of the degenerative cardiovascular diseases. Its detection and characterization is currently based on morphological imaging techniques that do not provide information about its possible evolution in relation to biological activities profile. In this context, molecular imaging of thrombus has three main objectives: (1) detection of the initial thrombus and of secondary locations, (2) evaluation of the thrombus evolutive potential and its impact on surrounding tissues in relationship with its biological activity, and (3) early assessment of therapeutic efficacy (before morphological changes). The aim of this work was to develop molecular imaging agents of biological activities of ILT. Regarding the proaggregant activity, we demonstrated a relationship between annexin A5 signal intensity and vegetation proaggregant activity in a model of infective endocarditis. We also developed a novel P-selectin imaging agent based on a natural high affinity ligand (fucoidan), and validated its ability to detect ILT in vivo. Regarding the plasminergic activity of ILT, we used radiolabelled aprotinin to detect plasmin in human aneurysmal thrombus ex vivo; we also initiated a collaboration to optimize its radiolabelling using a cystein-free tag peptide in N-terminal position. In parallel we developed a new approach based on a peptide inhibitor conjugated with a bifunctional chelating agentPARIS-EST-Université (770839901) / SudocSudocFranceF

Can Nuclear Imaging Techniques Predict Patient Outcome and Guide Medical Management in Hereditary Transthyretin Cardiac Amyloidosis?

International audiencePurpose of Review Nuclear imaging recently gained a key role in the diagnosis and prognostic assessment of transthyretin (TTR)-related cardiac amyloidosis. This review aims at summarizing the state-of-the art regarding the implementation of nuclear imaging in the management of hereditary mutated TTR-cardiac amyloidosis (mTTR-CA). Recent Findings Although cardiac uptake of bone tracers is acknowledged as a specific marker of TTR amyloid cardiac burden, recent studies validated the implementation of bone scan in the flow chart for non-invasive diagnosis and follow-up of CA in multicenter trials. Simultaneously, cardiac denervation evidenced by MIBG scintigraphy proved to be a strong and independent prognostic marker of poor outcome in mTTR-CA. Summary By its unique ability to assess both amyloid burden and cardiac denervation, nuclear imaging may prove useful as part of multimodality imaging tools to trigger treatment initiation and monitoring in patients with mTTR-CA

Cardiac denervation evidenced by MIBG occurs earlier than amyloid deposits detection by Diphosphonates scintigraphy in patients with aTTR-FAP

International audienc

Cardiac denervation evidenced by MIBG occurs earlier than amyloid deposits detection by Diphosphonates scintigraphy in patients with aTTR-FAP

International audienc