Reversible regional wall motion abnormalities on exercise technetium-99m-gated cardiac single photon emission computed tomography predict high-grade angiographic stenoses.
OBJECTIVE
We sought to determine the level of angiographic stenosis at which reversible regional wall motion abnormalities (RWMA) are present on exercise stress technetium-99m (Tc-99m)- gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and whether assessments of stress and rest RWMA add incremental diagnostic information.


BACKGROUND
Stress and rest gated SPECT MPI enables the detection of post-exercise stunning. Although some studies have correlated RWMA to the severity of MPI defects, only one previous study correlated RWMA on gated MPI to angiographic findings. However, this correlation excluded patients with rest perfusion defects and did not involve gating of rest images.


METHODS
One hundred patients undergoing angiography within six months of exercise stress Tc-99m (sestamibi)-gated SPECT MPI (in the absence of interim cardiac events or revascularization) were recruited. Images were acquired 15 to 30 min after stress and interpreted without knowledge of the Duke treadmill score, left ventricular ejection fraction and angiographic data.


RESULTS
The sensitivity of reversible RWMA for angiographic stenoses >70% was 53%, with a specificity of 100%. The presence of reversible RWMA was able to stratify patients with angiographic stenoses of 50% to 79% and 80% to 99% with a high positive predictive value. A good correlation was noted between the presence of reversible RWMA and the coronary artery jeopardy score (R = 0.49, p < 0.0001). Multivariate analysis showed that the post-stress RWMA, Duke treadmill and reversible RWMA scores were significant predictors of angiographic severity.


CONCLUSIONS
Post-stress and reversible RWMA, as shown by exercise stress Tc-99m-gated SPECT MPI, are significant predictors of angiographic disease and add incremental value to MPI for the assessment of angiographic severity.
Emmett
Louise
L
Robert J. Burns Nuclear Cardiology Laboratory, Toronto Western Hospital, Toronto, Ontario, Canada.
Iwanochko
Robert M
RM
Freeman
Michael R
MR
Barolet
Alan
A
Lee
Douglas S
DS
Husain
Mansoor
M
D000367:Age Factors; D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis*; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D015640:Ion Channel Gating / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left / Q000502:physiology
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi