Imperial College London

ProfessorRichardUnderwood

Faculty of MedicineNational Heart & Lung Institute

Emeritus Professor of Cardiac Imaging
 
 
 
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Contact

 

+44 (0)20 7351 8811srunderwood

 
 
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Location

 

2.30Britten WingRoyal Brompton Campus

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Summary

 

Publications

Publication Type
Year
to

443 results found

Hirschfeld CB, Mercuri M, Pascual TNB, Karthikeyan G, Vitola JV, Mahmarian JJ, Better N, Bouyoucef SE, Hee-Seung Bom H, Lele V, Magboo VPC, Alexánderson E, Allam AH, Al-Mallah MH, Dorbala S, Flotats A, Jerome S, Kaufmann PA, Luxenburg O, Shaw LJ, Underwood SR, Rehani MM, Paez D, Dondi M, Einstein AJ, INCAPS Investigators Groupet al., 2021, Worldwide variation in the use of nuclear cardiology camera technology, reconstruction software, and imaging protocols, JACC: Cardiovascular Imaging, Vol: 14, Pages: 1819-1828, ISSN: 1876-7591

OBJECTIVES: This study sought to describe worldwide variations in the use of myocardial perfusion imaging hardware, software, and imaging protocols and their impact on radiation effective dose (ED). BACKGROUND: Concerns about long-term effects of ionizing radiation have prompted efforts to identify strategies for dose optimization in myocardial perfusion scintigraphy. Studies have increasingly shown opportunities for dose reduction using newer technologies and optimized protocols. METHODS: Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study) registry, a multinational, cross-sectional study comprising 7,911 imaging studies from 308 labs in 65 countries. The study compared regional use of camera technologies, advanced post-processing software, and protocol characteristics and analyzed the influence of each factor on ED. RESULTS: Cadmium-zinc-telluride and positron emission tomography (PET) cameras were used in 10% (regional range 0% to 26%) and 6% (regional range 0% to 17%) of studies worldwide. Attenuation correction was used in 26% of cases (range 10% to 57%), and advanced post-processing software was used in 38% of cases (range 26% to 64%). Stress-first single-photon emission computed tomography (SPECT) imaging comprised nearly 20% of cases from all world regions, except North America, where it was used in just 7% of cases. Factors associated with lower ED and odds ratio for achieving radiation dose ≤9 mSv included use of cadmium-zinc-telluride, PET, advanced post-processing software, and stress- or rest-only imaging. Overall, 39% of all studies (97% PET and 35% SPECT) were ≤9 mSv, while just 6% of all studies (32% PET and 4% SPECT) achieved a dose ≤3 mSv. CONCLUSIONS: Newer-technology cameras, advanced software, and stress-only protocols were associated with reduced ED, but worldwide adoption of these practices was generally low and varied significantly between regions. The im

Journal article

Schofield R, Menezes L, Underwood SR, 2021, Nuclear cardiology: state of the art., Heart, Vol: 107, Pages: 954-961, ISSN: 1355-6037

Radionuclide imaging remains an essential component of modern cardiology. There is overlap with the information from other imaging techniques, but no technique is static and new developments have expanded its role. This review focuses on ischaemic heart disease, heart failure, infection and inflammation. Radiopharmaceutical development includes the wider availability of positron emission tomography (PET) tracers such as rubidium-82, which allows myocardial perfusion to be quantified in absolute terms. Compared with alternative techniques, myocardial perfusion scintigraphy PET and single photon emission computed tomography (SPECT) have the advantages of being widely applicable using exercise or pharmacological stress, full coverage of the myocardium and a measure of ischaemic burden, which helps to triage patients between medical therapy and revascularisation. Disadvantages include the availability of expertise in some cardiac centres and the lack of simple SPECT quantification, meaning that global abnormalities can be underestimated. In patients with heart failure, despite the findings of the STICH (Surgical Treatment for Ischemic Heart Failure) trial, there are still data to support the assessment of myocardial hibernation in predicting when abolition of ischaemia might lead to improvement in ventricular function. Imaging of sympathetic innervation is well validated, but simpler markers of prognosis mean that it has not been widely adopted. There are insufficient data to support its use in predicting the need for implanted devices, but non-randomised studies are promising. Other areas where radionuclide imaging is uniquely valuable are detection and monitoring of endocarditis, device infection, myocardial inflammation in sarcoidosis, myocarditis and so on, and reliable detection of deposition in suspected transthyretin-related amyloidosis.

Journal article

Hirschfeld CB, Dondi M, Pascual TNB, Mercuri M, Vitola J, Karthikeyan G, Better N, Mahmarian JJ, Bouyoucef SE, Hee-Seung Bom H, Lele V, Magboo VPC, Alexánderson E, Allam AH, Al-Mallah MH, Flotats A, Jerome S, Kaufmann PA, Luxenburg O, Underwood SR, Rehani MM, Vassileva J, Paez D, Einstein AJ, INCAPS Investigators Groupet al., 2021, Worldwide diagnostic reference levels for single-photon emission computed tomography myocardial perfusion imaging: findings from INCAPS., JACC: Cardiovascular Imaging, Vol: 14, Pages: 657-665, ISSN: 1876-7591

OBJECTIVES: This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). BACKGROUND: Reference levels serve as radiation dose benchmarks to compare individual laboratories against aggregated data, helping to identify sites in greatest need of dose reduction interventions. DRLs for SPECT MPI have previously been derived from national or regional registries. To date there have been no multiregional reports of DRLs for SPECT MPI from a single standardized dataset. METHODS: Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study), a cross-sectional, multinational registry of MPI protocols. A total of 7,103 studies were included. DRLs and AAAs were calculated by protocol for each world region and for aggregated worldwide data. RESULTS: The aggregated worldwide DRLs for rest-stress or stress-rest studies employing technetium Tc 99m-labeled radiopharmaceuticals were 11.2 mCi (first dose) and 32.0 mCi (second dose) for 1-day protocols, and 23.0 mCi (first dose) and 24.0 mCi (second dose) for multiday protocols. Corresponding AAAs were 10.1 mCi (first dose) and 28.0 mCi (second dose) for 1-day protocols, and 17.8 mCi (first dose) and 18.7 mCi (second dose) for multiday protocols. For stress-only technetium Tc 99m studies, the worldwide DRL and AAA were 18.0 mCi and 12.5 mCi, respectively. Stress-first imaging was used in 26% to 92% of regional studies except in North America where it was used in just 7% of cases. Significant differences in DRLs and AAAs were observed between regions. CONCLUSIONS: This study reports reference levels for SPECT MPI for each major world region from one of the largest international registries of clinical MPI studies. Regional DRLs may be useful in establishing or revising guidelines or simply comparing individual laboratory

Journal article

Barron AJ, Xavier R, Al-Housni M, Reyes E, Underwood Ret al., 2020, Phase analysis, a novel SPECT technique for left ventricular dyssynchrony: Are degrees and milliseconds interchangeable?, JOURNAL OF NUCLEAR CARDIOLOGY, Vol: 27, Pages: 2273-2279, ISSN: 1071-3581

Journal article

Stirrup J, Gregg S, Baavour R, Roth N, Breault C, Agostini D, Ernst S, Underwood SRet al., 2020, Hybrid solid-state SPECT/CT left atrial innervation imaging for identification of left atrial ganglionated plexi: Technique and validation in patients with atrial fibrillation, Journal of Nuclear Cardiology, Vol: 27, Pages: 1939-1950, ISSN: 1071-3581

BACKGROUND: Ablating left atrial (LA) ganglionated plexi (GP), identified invasively by high-frequency stimulation (HFS) during pulmonary vein isolation (PVI), may reduce atrial fibrillation (AF) recurrence. 123I-metaiodobenzylguanidine (123I-mIBG) solid-state SPECT LA innervation imaging (LAII) has the spatial resolution to detect LAGP non-invasively but this has never been demonstrated in clinical practice. METHODS: 20 prospective patients with paroxysmal AF scheduled for PVI underwent 123I-mIBG LAII. High-resolution tomograms, reconstructed where possible using cardiorespiratory gating, were co-registered with pre-PVI cardiac CT. Location and reader confidence (1 [low] to 3 [high]) in discrete 123I-mIBG LA uptake areas (DUAs) were recorded and correlated with HFS. RESULTS: A total of 73 DUAs were identified, of which 59 (81%) were HFS positive (HFS +). HFS + likelihood increased with reader confidence (92% [score 3]). 64% of HFS-negative DUAs occurred over the lateral and inferior LA. Cardiorespiratory gating reduced the number of DUAs per patient (4 vs 7, P = .001) but improved: HFS + predictive value (76% vs 49%); reader confidence (2 vs 1, P = .02); and inter-observer, intra-observer, and inter-study agreement (κ = 0.84 vs 0.68; 0.82 vs 0.74; 0.64 vs 0.53 respectively). CONCLUSIONS: 123I-mIBG SPECT/CT LAII accurately and reproducibly identifies GPs verified by HFS, particularly when reconstructed with cardiorespiratory gating.

Journal article

Neglia D, Liga R, Caselli C, Carpeggiani C, Lorenzoni V, Sicari R, Lombardi M, Gaemperli O, Kaufmann PA, Scholte AJHA, Underwood SR, Knuuti Jet al., 2020, Anatomical and functional coronary imaging to predict long-term outcome in patients with suspected coronary artery disease: the EVINCI-outcome study, EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol: 21, Pages: 1273-1282, ISSN: 2047-2404

Journal article

Biddiscombe M, Matthews J, Wright M, Meah S, Underwood R, Barnes P, Shallcross D, Usmani Oet al., 2020, No evidence electric charge increases inhaled ultrafine particle deposition in human lungs, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936

Conference paper

Wechalekar K, Clark S, Hatipoglu S, Underwood SR, Keramida G, Maenhout A, Sharma R, Kouranos Vet al., 2020, Dietary compliance and interpretability of F-18-FDG PET-CT scans in diabetic population evaluated for cardiac sarcoidosis, 33rd Annual Congress of the European-Association-of-Nuclear-Medicine (EANM), Publisher: SPRINGER, Pages: S391-S391, ISSN: 1619-7070

Conference paper

van Diemen PA, Driessen RS, Kooistra RA, Stuijfzand WJ, Raijmakers PG, Boellaard R, Schumacher SP, Bom MJ, Everaars H, de Winter RW, van de Ven PM, Reiber JH, Min JK, Leipsic JA, Knuuti J, Underwood RS, van Rossum AC, Danad I, Knaapen Pet al., 2020, Comparison Between the Performance of Quantitative Flow Ratio and Perfusion Imaging for Diagnosing Myocardial Ischemia., JACC Cardiovasc Imaging, Vol: 13, Pages: 1976-1985

OBJECTIVES: This study compared the performance of the quantitative flow ratio (QFR) with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) myocardial perfusion imaging (MPI) for the diagnosis of fractional flow reserve (FFR)-defined coronary artery disease (CAD). BACKGROUND: QFR estimates FFR solely based on cine contrast images acquired during invasive coronary angiography (ICA). Head-to-head studies comparing QFR with noninvasive MPI are lacking. METHODS: A total of 208 (624 vessels) patients underwent technetium-99m tetrofosmin SPECT and [15O]H2O PET imaging before ICA in conjunction with FFR measurements. ICA was obtained without using a dedicated QFR acquisition protocol, and QFR computation was attempted in all vessels interrogated by FFR (552 vessels). RESULTS: QFR computation succeeded in 286 (52%) vessels. QFR correlated well with invasive FFR overall (R = 0.79; p < 0.001) and in the subset of vessels with an intermediate (30% to 90%) diameter stenosis (R = 0.76; p < 0.001). Overall, per-vessel analysis demonstrated QFR to exhibit a superior sensitivity (70%) in comparison with SPECT (29%; p < 0.001), whereas it was similar to PET (75%; p = 1.000). Specificity of QFR (93%) was higher than PET (79%; p < 0.001) and not different from SPECT (96%; p = 1.000). As such, the accuracy of QFR (88%) was superior to both SPECT (82%; p = 0.010) and PET (78%; p = 0.004). Lastly, the area under the receiver operating characteristics curve of QFR, in the overall sample (0.94) and among vessels with an intermediate lesion (0.90) was higher than SPECT (0.63 and 0.61; p < 0.001 for both) and PET (0.82; p < 0.001 and 0.77; p = 0.002), respectively. CONCLUSIONS: In this head-to-head comparative study, QFR exhibited a higher diagnostic value for detecting FFR-defined significant CAD compared

Journal article

Usmani OS, Matthews JC, Wright MD, Meah S, Underwood SR, Barnes PJ, Shallcross DE, Biddiscombe MFet al., 2020, No evidence electric charge increases inhaled ultrafine particle deposition in human lungs, American Journal of Respiratory and Critical Care Medicine, Vol: 201, Pages: 1301-1303, ISSN: 1073-449X

Journal article

van Diemen PA, Driessen RS, Stuijfzand WJ, Raijmakers PG, Schumacher SP, Bom MJ, Everaars H, Min JK, Leipsic JA, Knuuti J, Underwood SR, van de Ven PM, van Rossum AC, Danad I, Knaapen Pet al., 2020, Impact of scan quality on the diagnostic performance of CCTA, SPECT, and PET for diagnosing myocardial ischemia defined by fractional flow reserve, Journal of Cardiovascular Computed Tomography, Vol: 14, Pages: 60-67, ISSN: 1934-5925

BackgroundScan quality can have a significant effect on the diagnostic performance of non-invasive imaging techniques. However, the extent of its influence has scarcely been investigated in a head-to-head manner.MethodsTwo-hundred and eight patients underwent CCTA, SPECT, and PET prior to invasive fractional flow reserve measurements. Scan quality was classified as either good, moderate, or poor.ResultsDistribution of good, moderate, and poor quality scans was; CCTA; 66%, 22%, 13%; SPECT; 52%, 38%, 9%; PET; 86%, 13%, 1%. Good quality CCTA scans possessed a higher specificity (75% vs. 31%, p = 0.001), positive predictive value (PPV, 71% vs. 51%, p = 0.050), and accuracy (80% vs. 60%, p = 0.009) compared to moderate quality scans, while sensitivity (94%) and negative predictive value (NPV, 88%) were similar to moderate and poor quality scans. Sensitivity (76%), NPV (84%), and accuracy (85%) of good quality SPECT scans was superior to those of moderate (41% p = 0.001, 56% p = 0.010, 70% p = 0.010) and poor quality (30% p = 0.003, 65% p = 0.069, 63% p = 0.038). Specificity (92%) and PPV (87%) of good quality SPECT scans did not differ from scans of diminished quality. Good quality PET scans exhibited high sensitivity (84%), specificity (86%), NPV (88%), PPV (81%) and accuracy (85%), which was comparable to scans of lesser quality. Good quality CCTA, SPECT, and PET scans demonstrated a similar diagnostic accuracy (p = 0.247).ConclusionDiagnostic performance of CCTA, and SPECT is hampered by scan quality, while the diagnostic value of PET is not affected. Good quality CCTA, SPECT, and PET scans possess a high diagnostic accuracy.

Journal article

Reyes E, Underwood SR, 2020, Regadenoson myocardial perfusion scintigraphy for the evaluation of coronary artery disease in patients with lung disease: A series of five cases, Journal of Nuclear Cardiology, Vol: 27, Pages: 315-321, ISSN: 1071-3581

Coronary artery disease (CAD) is a leading cause of death and morbidity globally. Myocardial perfusion scintigraphy (MPS) is commonly used for the diagnosis of CAD, necessitating hyperaemia achieved either by physical exertion or by pharmacological stress, most commonly through use of a coronary arteriolar dilator. This is challenging in patients with respiratory conditions because exercise may be submaximal and adenosine is contraindicated because of the risk of bronchoconstriction. Regadenoson is the only selective adenosine A2A receptor agonist approved as a vasodilator in MPS. The risk of bronchospasm with regadenoson has been investigated in large, randomised trials; however, patients with the most severe respiratory conditions were not included. In this case series, we present the use of regadenoson MPS in five patients with moderate-to-severe lung conditions, including patients requiring lung volume reduction surgery and lung transplant. In all cases, regadenoson MPS provided valuable information for risk assessment and treatment optimisation. Although dyspnoea occurred in all patients, regadenoson was well tolerated without serious adverse events or bronchospasm; in no case was intervention required to treat dyspnoea.

Journal article

Lorenzoni V, Bellelli S, Caselli C, Knuuti J, Underwood SR, Neglia D, Turchetti G, Pietila M, Maki M, Teresinska A, Aguade-Bruix S, Nazarena Pizzi M, Todiere G, Gimelli A, Lombardi M, Puzzuoli S, Mangione M, Marcheschi P, Schroeder S, Drosch T, Poddighe R, Casolo G, Anagnostopoulos C, Pugliese F, Rouzet F, Le Guludec D, Cappelli F, Valente S, Gensini GF, Zawaideh C, Capitanio S, Sambuceti G, Marsico F, Filardi PP, Fernandez-Golfin C, Rincon LM, Zamorano JL, Graner FP, Nekolla S, de Graaf MA, Scholte AJHA, Fiechter M, Stehli J, Gaemperli O, Kaufmann PA, Reyes E, Nkomo S, Carpeggiani C, Giannessi D, Mariani F, Marinelli M, Sicari Ret al., 2019, Cost-effectiveness analysis of stand-alone or combined non-invasive imaging tests for the diagnosis of stable coronary artery disease: results from the EVINCI study, EUROPEAN JOURNAL OF HEALTH ECONOMICS, Vol: 20, Pages: 1437-1449, ISSN: 1618-7598

Journal article

van Diemen PA, Driessen RS, Stuijfzand WJ, Raijmakers PG, Schumacher SP, Bom MJ, Everaars H, Min JK, Leipsic JA, Knuuti J, Underwood SR, van de Ven PM, van Rossum AC, Danad I, Knaapen Pet al., 2019, Data on the impact of scan quality on the diagnostic performance of CCTA, SPECT, and PET for diagnosing myocardial ischemia defined by fractional flow reserve on a per vessel level, Data in Brief, Vol: 27, ISSN: 2352-3409

Scan quality directly impacts the diagnostic performance of non-invasive imaging modalities as reported in a substudy of the PACIFC-trial: "Impact of Scan Quality on the Diagnostic Performance of CCTA, SPECT, and PET for Diagnosing Myocardial Ischemia Defined by Fractional Flow Reserve" [1]. This Data-in-Brief paper supplements the hereinabove mentioned article by presenting the diagnostic performance of CCTA, SPECT, and PET on a per vessel level for the detection of hemodynamic significant coronary artery disease (CAD) when stratified according to scan quality and vascular territory.

Journal article

Lorenzoni V, Bellelli S, Caselli C, Knuuti J, Underwood SR, Neglia D, Turchetti Get al., 2019, Cost-effectiveness analysis of stand-alone or combined non-invasive imaging tests for the diagnosis of stable coronary artery disease: results from the EVINCI study (10.1007/s10198-019-01096-5, 2019), EUROPEAN JOURNAL OF HEALTH ECONOMICS, Vol: 20, Pages: 1451-1451, ISSN: 1618-7598

Journal article

Van Diemen PAA, Driessen RS, Kooistra RA, Stuijfzand WJ, Raijmakers PG, Schumacher SP, Bom MJ, Everaars H, Min JK, Leipsic JA, Knuuti J, Underwood SR, Van Rossum AC, Danad I, Knaapen Pet al., 2019, A comparison between the diagnostic performance of quantitative flow ratio and non-invasive imaging modalities for diagnosing myocardial ischemia defined by FFR, a PACIFIC-trial interim analysis, Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology, Publisher: OXFORD UNIV PRESS, Pages: 716-716, ISSN: 0195-668X

Conference paper

van Diemen P, Driessen R, Stuijfzand W, Schumacher S, Bom M, Everaars H, van de Ven P, Leipsic J, Knuuti J, Underwood S, van Rossum A, Danad I, Knaapen Pet al., 2019, Comparison Between the Diagnostic Performance of Quantitative Flow Ratio and Myocardial Perfusion Imaging for Detecting Myocardial Ischemia, 31st Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B112-B112, ISSN: 0735-1097

Conference paper

Driessen RS, Raijmakers PG, Danad I, Stuijfzand WJ, Schumacher SP, Lammertsma AA, van Rossum AC, van Royen N, Underwood SR, Knaapen Pet al., 2019, Adenosine single-photon emission computed tomography-derived transient ischemic dilatation and ejection fraction reserve fail to predict multivessel coronary artery disease, Nuclear Medicine Communications, Vol: 40, Pages: 773-774, ISSN: 0143-3636

ObjectiveNext to myocardial perfusion, single-photon emission computed tomography (SPECT) also allows for assessment of non-perfusion parameters such as transient ischemic dilatation (TID) and a reduction of ejection fraction (EF) with stress imaging. The present study aimed to evaluate the diagnostic value of TID and EF reserve for the detection of significant multivessel coronary artery disease (CAD).MethodsA total of 206 patients with suspected stable coronary artery disease prospectively underwent gated stress-rest 99mTc-tetrofosmin SPECT and invasive coronary angiography with routine fractional flow reserve (FFR) measurements, regardless of imaging results. Left ventricular (LV) volumes, TID and EF reserve were assessed and compared with FFR defined severity of CAD.ResultsAccording to FFR, 92 (45%) patients had significant CAD, whereas 25 (12%) showed two vessel disease and 22 (11%) showed three vessel disease (3-VD). With an increasing extent of CAD, TID values and EF reserve did not significantly change (p = 0.07 and p = 0.42 for trend, respectively). Conversely, absolute LV volumes and EF differed significantly among groups of CAD severity (p < 0.01 for all trends).ConclusionSPECT derived TID and EF reserve did not differ between patients with high risk CAD (3-VD) and low risk or no significant CAD. Therefore the present results advocate exert caution when using these ancillary findings in clinical practice.

Journal article

Driessen RS, Danad I, Stuijfzand WJ, Raijmakers PG, Schumacher SP, van Diemen PA, Leipsic JA, Knuuti J, Underwood SR, van de Ven PM, van Rossum AC, Taylor CA, Knaapen Pet al., 2019, Comparison of coronary computed tomography angiography, fractional flow reserve, and perfusion imaging for ischemia diagnosis, Journal of the American College of Cardiology, Vol: 73, Pages: 161-173, ISSN: 0735-1097

BackgroundFractional flow reserve (FFR) computation from coronary computed tomography angiography (CTA) datasets (FFRCT) has emerged as a promising noninvasive test to assess hemodynamic severity of coronary artery disease (CAD), but has not yet been compared with traditional functional imaging.ObjectivesThe purpose of this study was to evaluate the diagnostic performance of FFRCT and compare it with coronary CTA, single-photon emission computed tomography (SPECT), and positron emission tomography (PET) for ischemia diagnosis.MethodsThis subanalysis involved 208 prospectively included patients with suspected stable CAD, who underwent 256-slice coronary CTA, 99mTc-tetrofosmin SPECT, [15O]H2O PET, and routine 3-vessel invasive FFR measurements. FFRCT values were retrospectively derived from the coronary CTA images. Images from each modality were interpreted by core laboratories, and their diagnostic performances were compared using invasively measured FFR ≤0.80 as the reference standard.ResultsIn total, 505 of 612 (83%) vessels could be evaluated with FFRCT. FFRCT showed a diagnostic accuracy, sensitivity, and specificity of 87%, 90%, and 86% on a per-vessel basis and 78%, 96%, and 63% on a per-patient basis, respectively. Area under the receiver-operating characteristic curve (AUC) for identification of ischemia-causing lesions was significantly greater for FFRCT (0.94 and 0.92) in comparison with coronary CTA (0.83 and 0.81; p < 0.01 for both) and SPECT (0.70 and 0.75; p < 0.01 for both), on a per-vessel and -patient level, respectively. FFRCT also outperformed PET on a per-vessel basis (AUC 0.87; p < 0.01), but not on a per-patient basis (AUC 0.91; p = 0.56). In the intention-to-diagnose analysis, PET showed the highest per-patient and -vessel AUC followed by FFRCT (0.86 vs. 0.83; p = 0.157; and 0.90 vs. 0.79; p = 0.005, respectively).ConclusionsIn this study, FFRCT showed higher diagnostic performance than standard coronary CTA, SPECT, and PET for vess

Journal article

Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, ESC Scientific Document Groupet al., 2019, Fourth universal definition of myocardial infarction (2018), European Heart Journal, Vol: 40, Pages: 237-269, ISSN: 1522-9645

Journal article

Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Mickley H, Crea F, Van de Werf F, Bucciarelli-Ducci C, Katus HA, Pinto FJ, Antman EM, Hamm CW, de Caterina R, Underwood SR, Canty JM, Lyon AR, Devereaux PJ, Luis Zamorano J, Lindahl B, Weintraub WS, Newby LK, Virmani R, Vranckx P, Cutlip D, Gibbons RJ, Smith SC, Atar D, Luepker RV, Robertson RM, Bonow RO, Steg PG, O'Gara PT, Fox KAAet al., 2019, Fourth universal definition of myocardial infarction (2018), REVISTA ESPANOLA DE CARDIOLOGIA, Vol: 72, ISSN: 0300-8932

Journal article

Kouranos V, Sharma R, Khattar R, Baksi J, Kokosi M, Prasad S, Wechalekar K, Underwood R, Cowie M, Wells Aet al., 2018, Cardiac sarcoidosis: a tertiary centre experience, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936

Conference paper

Mazzanti M, Shirka E, Pugliese F, Gjergo H, Goda A, Pottle A, Hasimi E, Deane SE, Dent N, Mackay N, Underwood Ret al., 2018, Usefulness of clinical decision support system as tool of good clinical practice in patients at low risk of coronary artery disease. The ARTICA co-operative database, European-Society-of-Cardiology Congress, Publisher: OXFORD UNIV PRESS, Pages: 41-42, ISSN: 0195-668X

Conference paper

Driessen RS, Danad I, Stuijfzand WJ, Raijmakers PG, Min JK, Leipsic JA, Underwood SR, De Ven PMV, Van Rossum AC, Van Royen N, Taylor CA, Knaapen Pet al., 2018, Head-to-head comparison of FFR-CT against coronary CT angiography and myocardial perfusion imaging for the diagnosis of ischaemia, European-Society-of-Cardiology Congress, Publisher: OXFORD UNIV PRESS, Pages: 234-235, ISSN: 0195-668X

Conference paper

Mazzanti M, Shirka E, Pugliese F, Gjergo H, Goda A, Pottle A, Hasimi E, Deane SE, Dent N, Mackay N, Underwood SEet al., 2018, Underuse of non-invasive functional imaging in patients at intermediate risk of coronary artery disease. A decision support system in the clinical practice. The ARTICA database, European-Society-of-Cardiology Congress, Publisher: OXFORD UNIV PRESS, Pages: 41-41, ISSN: 0195-668X

Conference paper

Driessen RS, Raijmakers PG, Danad I, Stuijfzand WJ, Schumacher SP, Leipsic JA, Min JK, Knuuti J, Lammertsma AA, van Rossum AC, van Royen N, Underwood SR, Knaapen Pet al., 2018, Automated SPECT analysis compared with expert visual scoring for the detection of FFR-defined coronary artery disease, European Journal of Nuclear Medicine and Molecular Imaging, Vol: 45, Pages: 1091-1100, ISSN: 1619-7070

PurposeTraditionally, interpretation of myocardial perfusion imaging (MPI) is based on visual assessment. Computer-based automated analysis might be a simple alternative obviating the need for extensive reading experience. Therefore, the aim of the present study was to compare the diagnostic performance of automated analysis with that of expert visual reading for the detection of obstructive coronary artery disease (CAD).Methods206 Patients (64% men, age 58.2 ± 8.7 years) with suspected CAD were included prospectively. All patients underwent 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) and invasive coronary angiography with fractional flow reserve (FFR) measurements. Non-corrected (NC) and attenuation-corrected (AC) SPECT images were analyzed both visually as well as automatically by commercially available SPECT software. Automated analysis comprised a segmental summed stress score (SSS), summed difference score (SDS), stress total perfusion deficit (S-TPD), and ischemic total perfusion deficit (I-TPD), representing the extent and severity of hypoperfused myocardium. Subsequently, software was optimized with an institutional normal database and thresholds. Diagnostic performances of automated and visual analysis were compared taking FFR as a reference.ResultsSensitivity did not differ significantly between visual reading and most automated scoring parameters, except for SDS, which was significantly higher than visual assessment (p < 0.001). Specificity, however, was significantly higher for visual reading than for any of the automated scores (p < 0.001 for all). Diagnostic accuracy was significantly higher for visual scoring (77.2%) than for all NC images scores (p < 0.05), but not compared with SSS AC and S-TPD AC (69.8% and 71.2%, p = 0.063 and p = 0.134). After optimization of the automated software, diagnostic accuracies were similar for vi

Journal article

Nunes MCP, Badano LP, Antonio Marin-Neto J, Edvardsen T, Fernandez-Golfin C, Bucciarelli-Ducci C, Popescu BA, Underwood R, Habib G, Luis Zamorano J, Saraiva RM, Sabino EC, Botoni FA, Barbosa MM, Barros MVL, Falqueto E, Simoes MV, Schmidt A, Rochitte CE, Rocha MOC, Pinho Ribeiro AL, Lancellotti Pet al., 2018, Multimodality imaging evaluation of Chagas disease: an expert consensus of Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI), EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol: 19, Pages: 459-+, ISSN: 2047-2404

Journal article

Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Mickley H, Crea F, Van de Werf F, Bucciarelli-Ducci C, Katus HA, Pinto FJ, Antman EM, Hamm CW, De Caterina R, Januzzi JL, Apple FS, Alonso Garcia MA, Underwood SR, Canty JM, Lyon AR, Devereaux PJ, Zamorano JL, Lindahl B, Weintraub WS, Newby LK, Virmani R, Vranckx P, Cutlip D, Gibbons RJ, Smith SC, Atar D, Luepker RV, Robertson RM, Bonow RO, Steg PG, O'Gara PT, Fox KAAet al., 2018, [Fourth universal definition of myocardial infarction (2018)]., Kardiol Pol, Vol: 76, Pages: 1383-1415

Journal article

Stirrup J, Voss U, Gregg S, Baavour R, Roth N, Breault C, Ernst S, Underwood Set al., 2017, Inter-study reproducibility of SPECT I-123-mIBG left atrial innervation imaging for the identification of left atrial ganglionated plexi in patients with paroxysmal atrial fibrillation, Publisher: SPRINGER, Pages: S266-S266, ISSN: 1619-7070

Conference paper

Danad I, Raijmakers PG, Driessen RS, Leipsic J, Raju R, Naoum C, Knuuti J, Mäki M, Underwood RS, Min JK, Elmore K, Stuijfzand WJ, van Royen N, Tulevski II, Somsen AG, Huisman MC, van Lingen AA, Heymans MW, van de Ven PM, van Kuijk C, Lammertsma AA, van Rossum AC, Knaapen Pet al., 2017, Comparison of Coronary CT Angiography, SPECT, PET, and Hybrid Imaging for Diagnosis of Ischemic Heart Disease Determined by Fractional Flow Reserve., JAMA Cardiol, Vol: 2, Pages: 1100-1107

Importance: At present, the choice of noninvasive testing for a diagnosis of significant coronary artery disease (CAD) is ambiguous, but nuclear myocardial perfusion imaging with single-photon emission tomography (SPECT) or positron emission tomography (PET) and coronary computed tomography angiography (CCTA) is predominantly used for this purpose. However, to date, prospective head-to-head studies are lacking regarding the diagnostic accuracy of these imaging modalities. Furthermore, the combination of anatomical and functional assessments configuring a hybrid approach may yield improved accuracy. Objectives: To establish the diagnostic accuracy of CCTA, SPECT, and PET and explore the incremental value of hybrid imaging compared with fractional flow reserve. Design, Setting, and Participants: A prospective clinical study involving 208 patients with suspected CAD who underwent CCTA, technetium 99m/tetrofosmin-labeled SPECT, and [15O]H2O PET with examination of all coronary arteries by fractional flow reserve was performed from January 23, 2012, to October 25, 2014. Scans were interpreted by core laboratories on an intention-to-diagnose basis. Hybrid images were generated in case of abnormal noninvasive anatomical or functional test results. Main Outcomes and Measures: Hemodynamically significant stenosis in at least 1 coronary artery as indicated by a fractional flow reserve of 0.80 or less and relative diagnostic accuracy of SPECT, PET, and CCTA in detecting hemodynamically significant CAD. Results: Of the 208 patients in the study (76 women and 132 men; mean [SD] age, 58 [9] years), 92 (44.2%) had significant CAD (fractional flow reserve ≤0.80). Sensitivity was 90% (95% CI, 82%-95%) for CCTA, 57% (95% CI, 46%-67%) for SPECT, and 87% (95% CI, 78%-93%) for PET, whereas specificity was 60% (95% CI, 51%-69%) for CCTA, 94% (95% CI, 88%-98%) for SPECT, and 84% (95% CI, 75%-89%) for PET. Single-photon emission tomography was found to be noninferior to PET in terms of

Journal article

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