title: Sex-specific approach to gated SPECT volumetric analysis after stress and at rest to detect high-risk coronary artery disease.
abstract: OBJECTIVE
  To determine the role of quantitative analysis of poststress and resting left ventricular function using sex-specific criteria to detect high-risk coronary artery disease (CAD) as defined by the Duke CAD Prognostic Index.
  
  
  RESULTS
  Stress technetium-99m-sestamibi-gated single-photon emission computed tomography and coronary angiography were performed in 407 consecutive patients (300 men, 107 women) with suspected CAD. The cut-off point for high-risk CAD was defined as a Duke CAD Prognostic Index of 42. The stress-to-rest ratios of end-diastolic volume (rEDV) and end-systolic volume (rESV) were analyzed. In 102 patients with high-risk CAD, the summed difference scores, rEDV and rESV, were greater than in 305 patients with low-risk to intermediate-risk CAD. The receiver operating characteristic curves revealed that the optimal cut-off points for rEDV and rESV to detect high-risk CAD were 1.10 and 1.11, respectively. Sex-specific rEDV was 1.08 in men, 1.11 in women, and sex-specific rESV was 1.09 in men and 1.20 in women. Multivariate discriminant analysis showed that the combination of sex-specific rEDV, sex-specific rESV, and summed difference scores greater than or equal to 8 best identified high-risk CAD, with a sensitivity of 75% and specificity of 76%.
  
  
  CONCLUSIONS
  The addition of a sex-specific approach to left ventricular functional analysis using gated single-photon emission computed tomography on conventional perfusion analysis, may help better identify patients with high-risk CAD as defined by the Duke CAD Prognostic Index.
authors.affiliation: Department of Cardiology, Tokyo Medical University, Tokyo, Japan. hida-bin@tokyo-med.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hida
authors.forename: Taishiro
authors.initials: T
authors.lastname: Chikamori
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yuko
authors.initials: Y
authors.lastname: Igarashi
authors.forename: Chie
authors.initials: C
authors.lastname: Shiba
authors.forename: Tsuguhisa
authors.initials: T
authors.lastname: Hatano
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Usui
authors.forename: Akira
authors.initials: A
authors.lastname: Yamashina
mesh_terms: D000368:Aged; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D055414:Myocardial Perfusion Imaging; D012146:Rest; D012189:Retrospective Studies; D012306:Risk; D012737:Sex Factors; D013312:Stress, Physiological; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology