Stress thallium-201/rest technetium-99m sequential dual-isotope high-speed myocardial perfusion imaging validation versus invasive coronary angiography.
BACKGROUND
Recent advances in nuclear myocardial perfusion imaging (MPI) have made it possible to develop a dual-isotope protocol for high-speed acquisition with image quality and radiation delivery comparable to that obtained with conventional single isotope protocols. So far, no study has compared dual-isotope high-speed MPI to invasive coronary angiography (ICA) in a large cohort using a Cadmium-zinc-telluride SPECT system.


METHODS
Over a 1-year period (May 2011 to April 2012), 1366 patients underwent dual-isotope high-speed MPI. Patients with ICA within 3 months after dual-isotope high-speed MPI were included together with patients with a low likelihood of coronary artery disease (CAD) in order to assess normalcy rate. Global summed stress score (SSS) and summed rest score (SRS) were calculated, and ICA results were analyzed independently. The main end point was a patient-based assessment of the diagnostic performance of dual-isotope high-speed MPI in detecting or ruling out significant CAD (>70% reduction in lumen diameter).


RESULTS
Inclusion criteria were fulfilled for 214 patients (143 men; age 60 ± 14 years; ICA, n = 104; low likelihood for CAD, n = 110). An exercise stress test was performed in 62% of patients and a pharmacological stress test was performed with either dipyridamole (32%) or dobutamine (6%). Average examination duration was 22.4 ± 4.5 minutes. Mean SSS, SRS, and SDS were 8.0 ± 4.9, 3.1 ± 4.3, and 5.0 ± 3.2, respectively. Prevalence of angiographic CAD was 75%. ICA detected stenosis in the left main trunk, left anterior descending artery, left circumflex artery, and right coronary artery in 4, 33, 31, and 42 patients, respectively. Sensitivity of dual-isotope high-speed MPI was 94%, normalcy rate was 92%, and accuracy was 83% for detecting CAD.


CONCLUSIONS
Dual-isotope high-speed MPI is reliable at detecting or ruling out CAD. NCT01785589.
Department of Cardiology, CHU Grenoble, University Hospital, BP 217, 38043, Grenoble Cedex 09, France, GBarone@chu-grenoble.fr.
Gilles
G
Barone-Rochette
Mélanie
M
Leclere
Alex
A
Calizzano
Estelle
E
Vautrin
Gallazzini-Crepin
GC
Céline
Alexis
A
Broisat
Catherine
C
Ghezzi
Jean Philippe
JP
Baguet
Jacques
J
Machecourt
Gérald
G
Vanzetto
Daniel
D
Fagret
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000000981:diagnostic imaging; D002104:Cadmium / Q000737:chemistry; D009202:Cardiomyopathies / Q000000981:diagnostic imaging; D015331:Cohort Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D055414:Myocardial Perfusion Imaging; D009683:Nuclear Medicine / Q000379:methods; D019275:Radiopharmaceuticals / Q000737:chemistry; D012146:Rest; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi / Q000737:chemistry*; D013691:Tellurium / Q000737:chemistry; D013794:Thallium Radioisotopes / Q000737:chemistry*; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging; D015032:Zinc / Q000737:chemistry
C474490:CdZnTe; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D002104:Cadmium; D017256:Technetium Tc 99m Sestamibi; D015032:Zinc; D013691:Tellurium