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[Usefulness of combination post-stress dysfunction and perfusion imaging in technetium-99m-tetrofosmin myocardial
1Department of Cardiology, Saitama Cardiovascular and Respiratory Center, Itai 1696, Konan-machi, Ohsato-gun, Saitama 360-0105.
Insights
Post-stress dysfunction, a measure of left ventricular function after stress, significantly improves the diagnosis of coronary artery disease when combined with myocardial perfusion imaging. This combined approach enhances detection rates, particularly in complex cases.
Area of Science:
- Cardiovascular Imaging
- Nuclear Cardiology
- Diagnostic Accuracy
Background:
- Myocardial perfusion imaging (MPI) exhibits reduced sensitivity for diagnosing coronary artery disease (CAD) in patients with three-vessel disease (3VD).
- Evaluating left ventricular (LV) post-stress dysfunction using electrocardiography (ECG) gated single-photon emission computed tomography (SPECT) offers a potential complementary diagnostic metric.
Observation:
- Post-stress LV dysfunction, defined by changes in ejection fraction (EF) and end-systolic volume (ESV), was significantly more prevalent in patients with CAD (30.3%) compared to those without (0VD, 6.0%).
- Patients with two-vessel disease (2VD) and 3VD showed higher rates of post-stress dysfunction (35.7% and 38.9%, respectively) than the 0VD group.
- MPI alone achieved a diagnostic sensitivity of 75% for CAD.
Findings:
- Combining post-stress LV dysfunction assessment with MPI improved diagnostic sensitivity for CAD from 75% to 82% (p < 0.05).
- This combined approach led to a slight, non-significant reduction in specificity from 92% to 86% (p = 0.08).
- Post-stress dysfunction was significantly elevated in patients with 2VD and 3VD compared to those with 0VD.
Implications:
- Post-stress LV dysfunction is a valuable parameter for enhancing the clinical diagnosis of coronary artery disease.
- The integration of LV post-stress dysfunction analysis with MPI improves the detection of CAD, especially in multi-vessel disease scenarios.
- This combined diagnostic strategy holds promise for more accurate and comprehensive CAD assessment.
Objectives:
Myocardial perfusion imaging has lower sensitivity for the diagnosis of coronary artery disease in patients with three-vessel disease. The presence of post-stress dysfunction of the left ventricle, evaluated by electrocardiography(ECG) gated single photon emission computed tomography(SPECT) with a quantitative gated SPECT program, was investigated in patients with coronary artery disease, and also whether combining post-stress dysfunction and myocardial perfusion imaging improved the diagnosis of coronary artery disease.
Methods:
ECG gated technetium-99m-tetrofosmin SPECT was performed using a one day, stress and rest, protocol in 139 patients. SPECT and coronary angiography were performed within 1 month. The coronary artery disease group consisted of 89 patients: 43 with one-vessel disease(1VD), 28 with two-vessel disease(2VD), and 18 with three-vessel disease(3VD). The group with zero-vessel disease(0VD) consisted of 50 patients. According to post-stress and rest ejection fraction(EF) and end-systolic volume (ESV), post-stress dysfunction is defined as follows: rest EF--post-stress EF > or = 5% and post-stress ESV--rest ESV > or = 5 ml.
Results:
In the coronary artery disease group, post-stress ESV was larger than rest ESV(37.8 +/- 26.4, 34.0 +/- 24.2 ml, p < 0.001), and post-stress EF was lower than rest EF (61.5 +/- 11.1%, 64.2 +/- 10.8%, p < 0.001). In the 0VD group, ESV and EF were the same for post-stress and rest (25.7 +/- 20.8, 26.2 +/- 21.6 ml, NS; 70.4 +/- 9.5%, 70.0 +/- 9.6%, NS). Post-stress dysfunction was 6.0% in the 0VD group and 30.3% in the coronary artery disease group(p < 0.001). Furthermore, post-stress dysfunction in the 2VD (35.7%) and 3VD(38.9%) groups was higher than that in the 0VD group(p < 0.01, p < 0.01). Sensitivity of coronary artery disease diagnosis by myocardial perfusion imaging was 75%. The combination of post-stress dysfunction and myocardial perfusion imaging improved sensitivity from 75% to 82%(p < 0.05), but reduced the specificity from 92% to 86%(p = 0.08).
Conclusions:
Post-stress dysfunction is a useful parameter for clinical diagnosis of coronary artery disease.