Clinical significance of right ventricular activity on treadmill thallium-201 myocardial single-photon emission computerized tomography using cadmium-zinc-telluride cameras.

Abstract

Identification of right ventricular (RV) abnormalities is important in patients with suspected coronary artery disease (CAD). RV activity can be better visualized on myocardial single-photon emission computerized tomography (SPECT) using a higher sensitivity cadmium-zinc-telluride (CZT) detector. The aim of this study was to investigate the clinical significance of RV/left ventricular (LV) uptake ratios during exercise thallium-201 SPECT using CZT detectors. A total of 102 patients underwent treadmill ECG-gated SPECT, coronary angiography, and echocardiography. SPECT myocardial perfusion was interpreted using a 17-segment model and a 0-4-point scale. RV/LV uptake ratios were calculated on the basis of maximum counts per pixel within the entire RV and LV walls. The relationships between RV/LV uptake ratio and gated SPECT, presence of CAD (≥50% stenosis in the left main or ≥70% in the main branches), demographics, and echocardiographic parameters were analyzed. Stress RV/LV ratios correlated positively with the presence of left main or multivessel disease, and tricuspid regurgitation maximum pressure gradient. After multivariate regression, stress/rest RV/LV ratios correlated positively with mitral flow deceleration time, age, female sex, and use of β-blockers. RV/LV uptake ratios on the basis of exercise myocardial perfusion SPECT imaging using CZT cameras are useful for the detection of severe CAD and could serve as an indicator of pulmonary hypertension and LV diastolic dysfunction.