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Updated: Jun 26, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Diagnostic value of left ventricular function after adenosine triphosphate loading and at rest in the detection of
Satoshi Hida1, Taishiro Chikamori, Hirokazu Tanaka
1Department of Cardiology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. hida-bin@tokyo-med.ac.jp
Insights
Quantitative analysis of left ventricular (LV) function post adenosine triphosphate (ATP) stress and at rest improves detection of extensive coronary artery disease (CAD). Combining LV volumes and ejection fraction with gated SPECT enhances multi-vessel CAD identification.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Transient left ventricular (LV) dilation is a known marker for extensive coronary artery disease (CAD).
- Quantitative analysis of LV function post adenosine triphosphate (ATP) stress and at rest is underutilized for detecting extensive CAD.
Purpose of the Study:
- To evaluate the utility of quantitative LV functional analysis during post-ATP stress and at rest using gated single-photon emission computed tomography (SPECT) for detecting multi-vessel CAD.
- To compare the diagnostic performance of LV functional parameters with conventional myocardial perfusion imaging in identifying extensive CAD.
Main Methods:
- One hundred nineteen patients with suspected CAD underwent gated SPECT with adenosine triphosphate (ATP) stress and at rest.
- LV volumes (end-diastolic volume [EDV], end-systolic volume [ESV]) and ejection fraction (EF) were analyzed, along with myocardial perfusion using a 20-segment model.
- Stress-induced volume ratio (SIVR) was calculated, and results were correlated with coronary angiography findings.
Main Results:
- Patients with multi-vessel CAD exhibited significantly higher summed stress scores (SSS), summed difference scores (SDS), post-stress increases in EDV and ESV, and SIVR compared to those with less severe CAD.
- A decrease in EF post-stress was more pronounced in patients with multi-vessel CAD.
- The combination of post-stress increase in ESV and SDS demonstrated the highest sensitivity (81%) and specificity (77%) for detecting multi-vessel CAD.
Conclusions:
- Integrating post-ATP stress and resting LV functional analysis with gated SPECT significantly improves the identification of multi-vessel CAD.
- LV functional parameters, particularly post-stress ESV and SDS, offer valuable diagnostic information beyond conventional perfusion analysis.
Background:
Although transient left ventricular (LV) dilation is a well-known marker for extensive coronary artery disease (CAD), few studies performed quantitative analysis of LV function of post adenosine triphosphate (ATP) stress and at rest to detect extensive CAD.
Methods:
One hundred nineteen patients with suspected CAD underwent post-stress and resting gated single-photon emission computed tomography (SPECT). Myocardial perfusion was assessed with a 20-segment model, and the changes in LV volume and function with ATP were analyzed. In addition, the stress-induced volume ratio (SIVR), defined as stress-to-rest ratios (end-systolic volume x 5 + end-diastolic volume), was calculated. All the patients underwent coronary angiography within 3 months of gated SPECT.
Results:
In the 62 patients with multi-vessel CAD, the summed stress score (SSS) (16.6 +/- 8.7 vs 11.5 +/- 9.1; P < .002), summed difference score (SDS) (9.6 +/- 5.8 vs 3.9 +/- 4.2; P < .0001), the post-stress increase in end-diastolic volume (EDV) (7.7 +/- 7.9 vs 2.2 +/- 5.3 mL; P < .0001), the post-stress increase in end-systolic volume (ESV) (9.4 +/- 6.0 vs 2.7 +/- 4.0 mL; P < .0001), and the (SIVR) (1.21 +/- 0.14 vs 1.06 +/- 0.10; P < .0001) were greater than in the 57 patients with insignificant or single-vessel CAD, whereas the post-stress increase in ejection fraction (EF) was less (-6.0 +/- 4.9 vs -2.0 +/- 4.4%; P < .0001). In the detection of multi-vessel CAD, an SSS of > or = 14 and an SDS of > or = 9 showed sensitivities of 57% and 52%, respectively, and specificities of 63% and 88%, respectively, while increase in EDV of > or = 6 mL, increase in ESV of > or = 6 mL, decrease in EF of > or = 5% after stress, and SIVR of > or = 1.13 demonstrated sensitivities of 60%, 81%, 60%, and 74% and specificities of 74%, 77%, 77%, and 79%, respectively. The multivariate discriminant analysis revealed that the combination of post-stress increase in ESV and the SDS best identified multi-vessel CAD, with 81% sensitivity and 77% specificity (chi(2) = 63.6), whereas the SDS alone showed 52% sensitivity and 88% specificity (chi(2) = 22.4).
Conclusions:
The addition of "post-ATP stress" and "at rest" LV functional analysis using gated SPECT to conventional perfusion analysis helps to better identify patients with multi-vessel CAD.
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