Abstract 8: Association Between Abnormalities in Myocardial Perfusion and Patient-reported Angina Among Patients With Known Coronary Artery Disease: PET vs. SPECT Comparison

Abstract

Background: Although the burden of angina would be expected to be intricately linked with the degree of myocardial ischemia, prior work with stress echocardiography and SPECT myocardial perfusion imaging (MPI) have shown these two measures to be poorly correlated. We examined the association of positron emission tomography (PET) MPI, which can more accurately characterize myocardial ischemia, with angina. Methods: Patients with known CAD who were referred for a clinically-indicated vasodilator MPI at Saint Luke’s Hospital (Kansas City, MO) were included. All patients underwent both SPECT and PET MPI and completed the Seattle Angina Questionnaire (SAQ) at the time of MPI. SAQ angina frequency (AF) and physical limitation (PL) scores were compared across the spectrum of ischemic burden (no ischemia, <5, 5-10 and >10% ischemic myocardium) with PET and SPECT. Results: Among 322 patients with CAD undergoing MPI (mean age 66.3 ± 9.7 years; 64.9% men), mean SAQ AF and PL scores were 78.5 ± 19 and 83.3 ± 19.8, respectively. A total of 72 patients (44.7%) with PET and 67 (41.6%) with SPECT had at least mild ischemia on MPI. There was no association with burden of angina by SAQ AF or PL scores and degree of ischemia by PET or SPECT MPI (Figure). Conclusion: We found no association between patient-reported angina and the burden of ischemia, regardless of the modality used. These findings suggest that other complex, multi-system pathways likely impact perception of pain and description of angina in patients with CAD, and that direct measurement of patient-reported symptoms needs to supplement physiologic assessment of ischemia.