Impact of combined supine and prone myocardial perfusion imaging using an ultrafast cardiac gamma camera for detection of inferolateral coronary artery disease.
BACKGROUND
Although combined supine and prone acquisitions improve the detection of inferolateral obstructive coronary artery disease (CAD), the predictors of inaccurate detection of inferolateral ischemia have not been reported by using cadmium zinc telluride (CZT) myocardial perfusion imaging (MPI).


RESULTS
Vasodilator stress (99m)Tc tetrofosmin MPI using CZT camera and coronary angiography was performed in 322 patients within an interval of 2 months. Prone MPI was performed immediately after supine MPI. Narrowing of the luminal diameter ≥ 75% was considered significant. The presence of an abnormality on both supine and prone images was considered significant. Combined supine and prone imaging, compared with supine-only quantification, was more specific (93% vs. 72%, respectively, p<0.0001) and accurate (88% vs. 74%, p<0.0001) without compromising sensitivity (82% vs. 68%, p=0.10). The area under the curve for detecting inferolateral ischemia was 0.769 (95% CI 0.705-0.833) for supine imaging and 0.802 (95% CI 0.730-0.875) for combined supine and prone imaging (p<0.05). Multivariable analysis revealed that previous inferolateral myocardial infarction was an independent predictor of a false diagnosis (odds ratio=3.45, 95% confidence interval [CI] 1.62-7.37, p<0.001).


CONCLUSIONS
Combined supine and prone quantitative CZT MPI enhances the detection of inferolateral CAD without adversely affecting its sensitivity. However, we recommend inferolateral ischemia be monitored in patients with a history of previous inferolateral MI because previous inferolateral MI is a predictor of inaccurate diagnosis.
Fukuyama Cardiovascular Hospital, Fukuyama, Japan. Electronic address: kgoto0369@yahoo.co.jp.
Kenji
K
Goto
Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
Hideo
H
Takebayashi
Hiroshima University Graduate School of Biomedical Science, Hiroshima, Japan.
Yasuki
Y
Kihara
Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
Hiroki
H
Yamane
Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
Arata
A
Hagikura
Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
Yoshimasa
Y
Morimoto
Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
Yuetsu
Y
Kikuta
Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
Katsumasa
K
Sato
Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
Masahito
M
Taniguchi
Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
Shigeki
S
Hiramatsu
Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
Seiichi
S
Haruta
D000368:Aged; D002104:Cadmium; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D008297:Male; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D056888:Patient Positioning; D016684:Prone Position; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016683:Supine Position; D013691:Tellurium; D015899:Tomography, Emission-Computed, Single-Photon; D015032:Zinc
C474490:CdZnTe; D002104:Cadmium; D015032:Zinc; D013691:Tellurium
(99m)Tc tetrofosmin; Coronary artery disease; Myocardial perfusion imaging; Prone; Supine