Patient satisfaction with coronary CT angiography, myocardial CT perfusion, myocardial perfusion MRI, SPECT myocardial perfusion imaging and conventional coronary angiography
- 644 Downloads
To evaluate patient acceptance of noninvasive imaging tests for detection of coronary artery disease (CAD), including single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), stress perfusion magnetic resonance imaging (MRI), coronary CT angiography (CTA) in combination with CT myocardial stress perfusion (CTP), and conventional coronary angiography (CCA).
Intraindividual comparison of perception of 48 patients from the CORE320 multicentre multinational study who underwent rest and stress SPECT-MPI with a technetium-based tracer, combined CTA and CTP (both with contrast agent, CTP with adenosine), MRI, and CCA. The analysis was performed by using a validated questionnaire.
Patients had significantly more concern prior to CCA than before CTA/CTP (p < 0.001). CTA/CTP was also rated as more comfortable than SPECT-MPI (p = 0.001). Overall satisfaction with CT was superior to that of MRI (p = 0.007). More patients preferred CT (46 %; p < 0.001) as a future diagnostic test. Regarding combined CTA/CTP, CTP was characterised by higher pain levels and an increased frequency of angina pectoris during the examination (p < 0.001). Subgroup analysis showed a higher degree of pain during SPECT-MPI with adenosine stress compared to physical exercise (p = 0.016).
All noninvasive cardiac imaging tests are well accepted by patients, with CT being the preferred examination.
• A variety of cardiac imaging tests is available without known patient preference
• CTA/CTP shows a lower degree of concern than conventional coronary angiography
• CTA/CTP shows higher overall satisfaction compared to stress perfusion magnetic resonance imaging
• CTA/CTP is rated as more comfortable than SPECT-MPI
• CTA/CTP is the preferred cardiac imaging test
KeywordsCoronary artery disease Multidetector computed tomography Single-photon emission computed tomography Stress perfusion magnetic resonance imaging Patient satisfaction
Beats per minute
Coronary artery disease
Conventional coronary angiography
Stress perfusion magnetic resonance imaging
Coronary computed tomography angiography
Computed tomography myocardial stress perfusion
Fractional flow reserve
Percutaneous coronary intervention
Single-photon emission computed tomography myocardial perfusion imaging
Visual analog scale
The scientific guarantor of this publication is Professor Marc Dewey. The authors of this manuscript declare relationships with the following companies: Prof. Dewey has received grant support from the Heisenberg Program of the DFG for a professorship (DE 1361/14-1), the FP7 Program of the European Commission for the randomized multicenter DISCHARGE trial (603266-2, HEALTH-2012.2.4.-2), the European Regional Development Fund (20072013 2/05, 20072013 2/48), the German Heart Foundation/German Foundation of Heart Research (F/23/08, F/27/10), the Joint Program from the German Research Foundation (DFG) and the German Federal Ministry of Education and Research (BMBF) for meta-analyses (01KG1013, 01KG1110, 01KG1110), GE Healthcare, Bracco, Guerbet, and Toshiba Medical Systems.
Prof. Dewey has received lecture fees from Toshiba Medical Systems, Guerbet, Cardiac MR Academy Berlin, and Bayer (Schering-Berlex).
Prof. Dewey is a consultant to Guerbet and one of the principal investigators of multi-center studies (CORE-64 and 320) on coronary CT angiography sponsored by Toshiba Medical Systems. He is also the editor of Coronary CT Angiography and Cardiac CT, both published by Springer, and offers hands-on workshops on cardiovascular imaging (www.ct-kurs.de). Prof. Dewey is an associate editor of Radiology and European Radiology.
Institutional master research agreements exist with Siemens Medical Solutions, Philips Medical Systems, and Toshiba Medical Systems. The terms of these arrangements are managed by the legal department of Charité – Universitätsmedizin Berlin. The CORE-320 study has received funding from Toshiba Medical Systems. Two of the authors (FR, RR) have significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all patients in this study.
The study subjects or cohorts have not been previously reported in regards to patient acceptance. The CORE-320 main study publication in regards to diagnostic accuracy has been published recently be Rochitte et al. (Eur Heart J 2014) and this is a single-centre substudy on the intraindividual patient perception of four cardiac imaging tests. Methodology: prospective, non-randomised controlled trial / intraindividual comparison, performed at one institution.
- 1.Dewey M, Zimmermann E, Deissenrieder F, Laule M, Dübel HP et al (2009) Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation 120:867–875PubMedCrossRefGoogle Scholar
- 7.Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG et al (2006) Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 114:1761–1791PubMedCrossRefGoogle Scholar
- 11.George RT, Arbab-Zadeh A, Miller JM, Vavere AL, Bengel FM et al (2012) Computed tomography myocardial perfusion imaging with 320-row detector computed tomography accurately detects myocardial ischemia in patients with obstructive coronary artery disease. Circ Cardiovasc Imaging 5:333–340PubMedCrossRefGoogle Scholar
- 12.Wang Y, Qin L, Shi X, Zeng Y, Jing H et al (2012) Adenosine-stress dynamic myocardial perfusion imaging with second-generation dual-source CT: comparison with conventional catheter coronary angiography and SPECT nuclear myocardial perfusion imaging. AJR Am J Roentgenol 198:521–529PubMedCrossRefGoogle Scholar
- 16.Ko SM, Choi JW, Hwang HK, Song MG, Shin JK et al (2012) Diagnostic performance of combined noninvasive anatomic and functional assessment with dual-source CT and adenosine-induced stress dual-energy CT for detection of significant coronary stenosis. AJR Am J Roentgenol 198:512–520PubMedCrossRefGoogle Scholar
- 17.Rief M, Zimmermann E, Stenzel F, Martus P, Stangl K et al (2013) Computed tomography angiography and myocardial computed tomography perfusion in patients with coronary stents: prospective intraindividual comparison with conventional coronary angiography. J Am Coll Cardiol 62:1476–1485PubMedCrossRefGoogle Scholar
- 24.George RT, Arbab-Zadeh A, Cerci RJ, Vavere AL, Kitagawa K et al (2011) Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320-MDCT: the CT angiography and perfusion methods of the CORE320 multicenter multinational diagnostic study. AJR Am J Roentgenol 197:829–837PubMedCentralPubMedCrossRefGoogle Scholar
- 25.Vavere AL, Simon GG, George RT, Rochitte CE, Arai AE et al (2011) Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320 row detector computed tomography: design and implementation of the CORE320 multicenter, multinational diagnostic study. J Cardiovasc Comput Tomogr 5:370–381PubMedCrossRefGoogle Scholar
- 27.Einstein AJ, Berman DS, Min JK, Hendel RC, Gerber TC et al (2014) Patient-centered imaging: shared decision making for cardiac imaging procedures with exposure to ionizing radiation. J Am Coll CardiolGoogle Scholar