Hybrid CCTA/SPECT myocardial perfusion imaging findings in patients with anomalous origin of coronary arteries from the opposite sinus and suspected concomitant coronary artery disease
Anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) are associated with adverse cardiac events. Discrimination between ACAOS and coronary artery disease (CAD)-related perfusion defects may be difficult. The aim of the present study was to investigate the value of hybrid coronary computed tomography angiography (CCTA)/SPECT-MPI in patients with ACAOS and possible concomitant CAD.
We retrospectively identified 46 patients (mean age 56 ± 12 years) with ACAOS revealed by CCTA who underwent additional SPECT-MPI. ACAOS with an interarterial course were classified as malignant, whereas all other variants were considered benign. CCTA/SPECT-MPI hybrid imaging findings (ischemia or scar) were analyzed according to the territory subtended by an anomalous vessel or a stenotic coronary artery.
Twenty-six (57%) patients presented with malignant ACAOS. Myocardial ischemia or scar was found only in patients who had concomitant obstructive CAD in the vessel matching the perfusion defect as evidenced by hybrid CCTA/SPECT imaging.
Hybrid CCTA/SPECT-MPI represents a valuable non-invasive tool to discriminate the impact of ACAOS from concomitant CAD on myocardial ischemia. Our results suggest that in a middle-aged population myocardial ischemia due to ACAOS per se may be exceedingly rare and is more likely attributable to concomitant CAD.
KeywordsHybrid CCTA SPECT anomalous coronary arteries originating from the opposite sinus of Valsalva ACAOS
Anomalous coronary arteries originating from the opposite sinus of Valsalva
Coronary computed tomography angiography
Single photon emission computed tomography
Myocardial perfusion imaging
Coronary artery disease
We thank Verena Weichselbaumer, Edlira Loga, and Ennio Mueller for their excellent technical support.
CG, DCB, CS, RRB, and PAK were responsible for the conception, design, analysis, and interpretation of the data and drafting of the manuscript. APP and OG were involved in the analysis and interpretation of the data and drafting of the manuscript. JV, FM, MP, OFC, JS, and TAF were involved in acquisition of data and drafting of the manuscript. All authors read and approved the final manuscript.
All authors have the following to disclose: The University Hospital of Zurich holds a research contract with GE Healthcare.
- 4.Clark RA, Marler AT, Lin CK, McDonough RJ, Prentice RL, Malik JA, et al. A review of anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) impact on major adverse cardiovascular events based on coronary computerized tomography angiography: A 6-year single center review. Ther Adv Cardiovasc Dis 2014;8:237-41.CrossRefPubMedGoogle Scholar
- 17.Uebleis C, Groebner M, von Ziegler F, Becker A, Rischpler C, Tegtmeyer R, et al. Combined anatomical and functional imaging using coronary CT angiography and myocardial perfusion SPECT in symptomatic adults with abnormal origin of a coronary artery. Int J Cardiovasc Imaging 2012;28:1763-74.CrossRefPubMedGoogle Scholar
- 18.Abbara S, Arbab-Zadeh A, Callister TQ, Desai MY, Mamuya W, Thomson L, et al. SCCT guidelines for performance of coronary computed tomographic angiography: A report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 2009;3:190-204.CrossRefPubMedGoogle Scholar
- 20.Pazhenkottil AP, Husmann L, Buechel RR, Herzog BA, Nkoulou R, Burger IA, et al. Validation of a new contrast material protocol adapted to body surface area for optimized low-dose CT coronary angiography with prospective ECG-triggering. Int J Cardiovasc Imaging 2010;26:591-7.CrossRefPubMedGoogle Scholar
- 26.Gebhard C, Fuchs TA, Stehli J, Gransar H, Berman DS, Budoff MJ, et al. Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: Results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry. Eur Heart J Cardiovasc Imaging 2015;16:853-62.CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Rispler S, Keidar Z, Ghersin E, Roguin A, Soil A, Dragu R, et al. Integrated single-photon emission computed tomography and computed tomography coronary angiography for the assessment of hemodynamically significant coronary artery lesions. J Am Coll Cardiol 2007;49:1059-67.CrossRefPubMedGoogle Scholar
- 35.Nasis A, Machado C, Cameron JD, Troupis JM, Meredith IT, Seneviratne SK. Anatomic characteristics and outcome of adults with coronary arteries arising from an anomalous location detected with coronary computed tomography angiography. Int J Cardiovasc Imaging 2015;31:181-91.CrossRefPubMedGoogle Scholar