Herzog, Bernhard A.

Husmann, Lars

Kaufmann, Philipp A.

Landmesser, Ulf

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7. Sharman JE, Haluska BA, Fang ZY, Prins JB, Marwick TH. Association of arterialwave properties and diastolic dysfunction in patients with type 2 diabetes mellitus.Am J Cardiol 2007;99:844–848.8. Rakebrandt F, Palombo C, Swampillai J, Scho¨n F, Donald A, Koza`kova` M, Kato K,Fraser AG. Arterial wave intensity and ventricular–arterial coupling by vascularultrasound—rationale and methods for the automated analysis of forwards andbackwards running waves. Ultrasound Med Biol 2009;35:266–277.9. Yu CM, Sanderson JE, Marwick TH, Oh JK. Tissue Doppler imaging. A new prog-nostic indicator for cardiovascular diseases. J Am Coll Cardiol 2007;49:1903–1914.10. The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects ofintensive glucose lowering in type 2 diabetes. N Engl J Med 2008;358:2545–2559.11. Kuznetsova T, Herbots L, Richart T, D’hooge J, Thijs L, Fagard RH,Herrogods MC, Staessen JA. Left ventricular strain and strain rate in a generalpopulation. Eur Heart J 2008;29:2014–2023.12. Schu¨nemann HJ, Oxman AD, Brozek J, Glasziou P, Jaeschke R, Vist GE,Williams JW, Kunz R, Craig J, Montori VM, Bossuyt P, Guyatt GH; GRADEWorking Group. Grading quality of evidence and strength of recommendationsfor diagnostic tests and strategies. BMJ 2008;336:1106–1110.13. Chan AKY, Sanderson JE, Wang T, Lam W, Yip G, Wang M, Lam YY, Zhang Y,Yeung L, Wu EB, Chan WWM, Wong JTH, So N, Yu CM. Aldosterone receptorantagonism induces reverse remodeling when added to angiotensin receptorblockade in chronic heart failure. J Am Coll Cardiol 2007;50:591–596.14. Solomon SD, Janardhanan R, Verma A, Bourgoun M, Daley WL, Purkayastha D,Lacourcie`re Y, Hippler SE, Fields H, Naqvi TZ, Mulvagh SL, Arnold JMO,Thomas JD, Zile MR, Aurigemma GP, for the Valsartan in Diastolic Dysfunction(VALIDD) Investigators. Effect of angiotensin receptor blockade and antihyper-tensive drugs on diastolic function in patients with hypertension and diastolic dys-function: a randomised trial. Lancet 2007;369:2079–2087.CARDIOVASCULAR FLASHLIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .doi:10.1093/eurheartj/ehn490Online publish-ahead-of-print 25 November 2008Low-dose computed tomography coronary angiography and myocardialperfusion imaging: cardiac hybrid imaging below 3mSvBernhard A. Herzog1, Lars Husmann1, Ulf Landmesser1, and Philipp A. Kaufmann1,2*1Cardiovascular Center, Raemistrasse 100, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland and 2Zurich Center for Integrative HumanPhysiology (ZIHP), University of Zurich, Zurich, Switzerland* Corresponding author: Tel: þ41 44 255 4196, Fax: þ41 44 255 4414, Email: pak@usz.chCardiac hybrid imaging allowsus combining the morphologi-cal information of CT coron-ary angiography (CTCA) andthe functional information ofmyocardial perfusion imaging(MPI) in the evaluation of cor-onary artery disease (CAD).However, the effective radi-ation dose to patients isoften an issue of discussionand may cause hesitation tohybrid imaging.We report on a 65-year-oldman (BMI: 24.6 kg/m2) withatypical chest pain, withoutcardiovascular risk factorsand no known CAD, whowas referred for cardiac check-up. The exercise test showed significant ST-depressions over the anterior leads. For further assess-ment, a low-dose CTCA (mean heart rate: 57 per minute with 10 mg metoprolol i.v.), using prospective ECG-triggering, and alow-dose 1-day gated adenosine stress SPECT-MPI with 173 MBq 99mTc-tetrofosmin were performed and fused. The SPECT-MPIwas reconstructed with a dedicated new iterative reconstruction software for low-count scans, including resolution recovery (‘Evalu-ation for Cardiac’, GE Healthcare, WI, USA). CTCA provided excellent image quality in all coronary segments at an effective radiationdose of 1.46 mSv, while the respective value for the MPI was 1.16 mSv. Thus, effective radiation dose for hybrid imaging was ,3mSv.Fused SPECT-CT demonstrated a perfusion defect at stress in the anterior myocardium (Panel A, black arrows), corresponding to thetotal occlusion (Panel A, white arrow) in the proximal left anterior descending (LAD) coronary artery. The latter was confirmed by theinvasive coronary angiography (ICA) (Panel B) for which the patient was referred without necessity of resting perfusion as wall motionabnormality was ruled out by gated stress SPECT excluding a myocardial scar. The diagnostic ICA confirmed an occlusion of the LAD,which was successfully re-canalized in the same session. This example illustrates that latest advances in non-invasive cardiac imagingallow comprehensive CAD as assessment by hybrid SPECT-CT imaging at radiation dose below 3 mSv.Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org.Editorial644

Low-dose computed tomography coronary angiography and myocardial perfusion imaging: cardiac hybrid imaging below 3mSv

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