Clinical usefulness of quantification of myocardial blood flow and flow reserve using CZT-SPECT for detecting coronary artery disease in patients with normal stress perfusion imaging

Abstract

BackgroundRelative myocardial perfusion imaging can misdiagnose “balanced” ischemia caused by coronary artery disease (CAD). We assessed the feasibility of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) using dynamic single-photon emission computed tomography (SPECT) with a cadmium-zinc-telluride (CZT) camera for estimating underlying CAD in patients with normal stress myocardial perfusion SPECT (MPS). Methods125 patients with normal stress MPS (summed stress score ≤3) were enrolled. All patients underwent coronary angiography (CAG) and stress/rest 201Tl dynamic SPECT for MBF and MPR calculation. The diagnostic accuracy of both these quantitative values and other clinical risk factors for predicting occult CAD were validated by CAG. ResultsMPR was 2.85 in patients with no CAD, 2.47 with 1-, 1.98 with 2-, and 1.76 with 3-vessel CAD. The patient’s age, morbidity of diabetes mellitus (DM), chronic kidney disease (CKD), stress MBF, and MPR were significantly associated with the presence of CAD (age, p=0.02; DM, p=0.005; CKD, p=0.005; creatinine level, p= 0.012, stress MBF, p=0.019, and MPR, p<0.001). Independent predictors in the multivariate regression analysis were as follows: DM, p=0.011, CKD, p=0.028, and MPR, p<0.001. The combined index was calculated from three independent predictors. Area under the receiver operating characteristic curve was 0.75 for MPR and 0.81 for the combined index. To identify CAD, sensitivity, and specificity for MPR were 77% and 66%, and for the combined index they were 79% and 66%, respectively. ConclusionQuantification of MPR and MBF using dynamic SPECT with a CZT camera can be useful to identify balanced ischemia caused by occult CAD in patients with normal stress MPS findings.