title: Myocardial perfusion imaging with a cadmium zinc telluride-based gamma camera versus invasive fractional flow reserve.
abstract: OBJECTIVE
  Recently introduced ultrafast cardiac SPECT cameras with cadmium zinc telluride-based (CZT) detectors may provide superior image quality allowing faster acquisition with reduced radiation doses. Although the level of concordance between conventional SPECT and invasive fractional flow reserve (FFR) measurement has been studied, that between FFR and CZT-based SPECT is not yet known. Therefore, we aimed to assess the level of concordance between CZT SPECT and FFR in a large patient group with stable coronary artery disease.
  
  
  METHODS
  Both invasive FFR and myocardial perfusion imaging with a CZT-based SPECT camera, using Tc-tetrofosmin as tracer, were performed in 100 patients with stable angina and intermediate grade stenosis on invasive coronary angiography. A cut-off value of <0.75 was used to define abnormal FFR.
  
  
  RESULTS
  The mean age of the patients was 64 ± 11 years, and 64 % were men. SPECT demonstrated ischaemia in 31 % of the patients, and 20 % had FFR <0.75. The concordance between CZT SPECT and FFR was 73 % on a per-patient basis and 79 % on a per-vessel basis. Discordant findings were more often seen in older patients and were mainly (19 %) the result of ischaemic SPECT findings in patients with FFR ≥ 0.75, whereas only 8 % had an abnormal FFR without ischaemia as demonstrated by CZT SPECT.
  
  
  CONCLUSIONS
  Only 20 - 30 % of patients with intermediate coronary stenoses had significant ischaemia as assessed by CZT SPECT or invasive FFR. CZT SPECT showed a modest degree of concordance with FFR, which is comparable with previous results with conventional SPECT. Further investigations are particularly necessary in patients with normal SPECT and abnormal FFR, especially to determine whether these patients should undergo revascularization.
authors: Department of Cardiology, Isala klinieken, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands, m.mouden@isala.nl.
authors: Mohamed
authors: M
authors: Mouden
authors: Jan Paul
authors: JP
authors: Ottervanger
authors: Siert
authors: S
authors: Knollema
authors: Jorik R
authors: JR
authors: Timmer
authors: Stoffer
authors: S
authors: Reiffers
authors: Ad H J
authors: AH
authors: Oostdijk
authors: Menko-Jan
authors: MJ
authors: de Boer
authors: Pieter L
authors: PL
authors: Jager
mesh_terms: D000368:Aged; D002104:Cadmium; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D015902:Gamma Cameras; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D013691:Tellurium; D015032:Zinc
chemical_list: C474490:CdZnTe; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D002104:Cadmium; C078700:technetium tc-99m tetrofosmin; D015032:Zinc; D013691:Tellurium