title: Quantitative exercise technetium-99m tetrofosmin myocardial tomography for the identification and localization of coronary artery disease.
abstract: The aim of this study was to evaluate the accuracy of quantitative 1-day exercise-rest technetium-99m tetrofosmin tomography in the identification of patients with coronary artery disease (CAD) and in the detection of individual stenosed coronary vessels. Sixty-one patients with suspected CAD who underwent coronary angiography and 13 normal volunteers were studied. All patients were submitted to two i.v. injections of 99mTc-tetrofosmin, one at peak exercise (370 MBq) and the other (1110 MBq) at rest 3 h after exercise (images 15-30 min after injection for both studies). All patients with CAD (>/=50% luminal stenosis) (n=50) had an abnormal 99mTc-tetrofosmin tomogram. Only one patient without significant coronary narrowing showed abnormal findings. Overall sensitivity, specificity and diagnostic accuracy in the detection of individual stenosed vessels were 77%, 93% and 85%, respectively. Sensitivity and diagnostic accuracy in the identification of individuals stenosed coronary vessels were significantly higher (P<0.05) in patients with single-vessel disease (n=21) than in those with multivessel disease (n=29). Sensitivity, specificity and accuracy for detecting individual diseased vessels were similar in patients without previous myocardial infarction (n=26) and in those with previous myocardial infarction (n=35). In myocardial territories related to non-infarcted areas (n=128), sensitivity and specificity in the detection of stenosed vessels were 70% and 95%, respectively. In infarcted areas (n=55), sensitivity and specificity in the detection of stenosed vessels were 85% (P=NS vs non-infarcted areas) and 75% (P<0.05 vs non-infarcted areas), respectively. Finally, sensitivity was significantly lower (P<0.05) in vascular territories supplied by vessels with moderate stenosis (50%-75%) than in those supplied by vessels with severe stenosis (>75%). The results of this study demonstrate that quantitative 1-day exercise-rest 99mTc-tetrofosmin single-photon emission tomographic imaging is a suitable and accurate technique to identify patients with CAD and to detect individual stenosed coronary vessels.
authors.affiliation: Centro per la Medicina Nucleare del Consiglio Nazionale delle Ricerche (CNR) and Cattedra di Medicina Nucleare, Università Federico II, Napoli, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Sullo
authors.forename: A
authors.initials: A
authors.lastname: Cuocolo
authors.forename: E
authors.initials: E
authors.lastname: Nicolai
authors.forename: S
authors.initials: S
authors.lastname: Cardei
authors.forename: A
authors.initials: A
authors.lastname: Nappi
authors.forename: F
authors.initials: F
authors.lastname: Squame
authors.forename: E M
authors.initials: EM
authors.lastname: Covelli
authors.forename: L
authors.initials: L
authors.lastname: Pace
authors.forename: M
authors.initials: M
authors.lastname: Salvatore
mesh_terms: D016022:Case-Control Studies; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D012680:Sensitivity and Specificity; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; C078700:technetium tc-99m tetrofosmin