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Does cardiac SPECT using attenuation and scatter correction accurately predict coronary artery disease in a minority
Aseem Vashist1, Dorothea Collins, Yogendra Prasad
1Division of Cardiology, Department of Medicine at Yale University School of Medicine, New Haven, CT 06510-3206, USA. aseem.vashist@yale.edu
Insights
Myocardial perfusion imaging (MPI) accurately predicts coronary artery disease (CAD) in minority women. A low-risk MPI scan indicates a favorable prognosis, reducing 2-year mortality risk.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Myocardial perfusion imaging (MPI) is a standard diagnostic tool for coronary artery disease (CAD).
- Validation of MPI's positive predictive value and prognostic capability in minority women is crucial.
Purpose of the Study:
- To validate the positive predictive value of MPI against cardiac catheterization.
- To assess the prognostic value of MPI in a cohort of minority women.
Main Methods:
- Retrospective analysis of minority women undergoing MPI and cardiac catheterization within 90 days.
- Exclusion of patients with recent revascularization.
- Utilization of attenuation/scatter correction for MPI interpretation.
Main Results:
- 18 out of 54 patients (53%) had MPI findings matching coronary angiography.
- MPI demonstrated a sensitivity of 87.2% and a positive predictive value of 75.6% compared to angiography.
- A low-risk MPI scan was associated with a favorable 2-year prognosis, with 9.3% mortality.
Conclusions:
- MPI's sensitivity in minority women is comparable to the general population.
- Specificity of MPI was lower in this cohort despite advanced correction techniques.
- A low-risk MPI scan is a significant predictor of favorable long-term survival.
Background:
Myocardial perfusion imaging (MPI) is a well-established diagnostic method for evaluation and risk stratification of coronary artery disease (CAD). We undertook this study to validate both the positive predictive value (when compared to cardiac catheterization) and the prognosis afforded by MPI in a group of minority women patients.
Material/Methods:
The database of our Nuclear Imaging and Catheterization Laboratory was retrospectively queried for consecutive minority (African-American, Hispanic and Asian) women patients who underwent MPI and cardiac catheterization within 90 days of each other. Patients with recent revascularization were excluded. Attenuation/scatter correction was utilized in the final interpretation of the study.
Results:
Of the 54 women patients who underwent MPI, 7 underwent exercise stress testing, 26 had stress testing with adenosine, 18 with dipyridamole and 3 with dobutamine. Eighteen patients (53%) had same number of vessels predicted by MPI and coronary angiography (7 patients with triple vessel disease, 7 with 2-vessel disease and 4 with single vessel disease). Five (3 with intermediate and 2 with high risk scans) out of the 54 patients (9.3%) were dead at 2 years. The sensitivity, specificity and positive predictive value of MPI as compared to angiography were 87.2%, 26.7%, 75.6% and 44.4% respectively.
Conclusions:
The sensitivity of MPI in this group of patients is comparable to the general population though the specificity is lower in spite of using attenuation and scatter correction. Low risk perfusion scan signifies favorable prognosis at 2 years with regards to mortality.
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