Prediction of left main or 3-vessel disease using myocardial perfusion reserve on dynamic thallium-201 single-photon emission computed tomography with a semiconductor gamma camera.
BACKGROUND
Myocardial perfusion imaging (MPI) may fail to detect balanced ischemia. We evaluated myocardial perfusion reserve (MPR) using Tl dynamic single-photon emission computed tomography (SPECT) and a novel cadmium zinc telluride (CZT) camera for predicting 3-vessel or left main coronary artery disease (CAD). METHODS AND RESULTS: A total of 55 consecutive patients with suspected CAD underwent SPECT-MPI and coronary angiography. The MPR index was calculated using the standard 2-compartment kinetic model. We analyzed the utility of MPR index, other SPECT findings, and various clinical variables. On multivariate analysis, MPR index and history of previous myocardial infarction (MI) predicted left main and 3-vessel disease. The area under the receiver operating characteristic curve was 0.81 for MPR index, 0.699 for history of previous MI, and 0.86 for MPR index plus history of previous MI. MPR index ≤1.5 yielded the highest diagnostic accuracy. Sensitivity, specificity, and accuracy were 86%, 78%, and 80%, respectively, for MPR index, 64%, 76%, 73% for previous MI, and 57%, 93%, and 84% for MPR index plus history of previous MI.


CONCLUSIONS
Quantification of MPR using dynamic SPECT and a novel CZT camera may identify balanced ischemia in patients with left main or 3-vessel disease.
Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University.
Shinya
S
Shiraishi
Fumi
F
Sakamoto
Noriko
N
Tsuda
Morikatsu
M
Yoshida
Seiji
S
Tomiguchi
Daisuke
D
Utsunomiya
Hisao
H
Ogawa
Yasuyuki
Y
Yamashita
D000368:Aged; D000369:Aged, 80 and over; D002104:Cadmium; D017023:Coronary Angiography / Q000295:instrumentation / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D013691:Tellurium; D013793:Thallium / Q000008:administration & dosage*; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation / Q000379:methods; D015032:Zinc
D002104:Cadmium; C027549:thallium chloride; D013793:Thallium; D015032:Zinc; D013691:Tellurium