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Updated: Mar 29, 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 ischemia severity at myocardial perfusion imaging in elderly persons with suspected coronary
Marco Canepa1, Gianpaolo Bezante, Pierfilippo Vianello
1aCardiovascular Unit, Department of Internal Medicine, University of Genova, Genova, Italy bLongitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, Maryland, USA cDepartment of Psychiatry, VU University Medical Center/GGZ in Geest, Amsterdam, The Netherlands dNuclear Medicine, Department of Health Science, University of Genova, Genova, Italy.
Insights
Myocardial perfusion scintigraphy (MPS) scores accurately diagnose coronary artery disease (CAD) in elderly individuals. Adjusting ischemia thresholds improves diagnostic specificity for CAD detection.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Myocardial perfusion scintigraphy (MPS) scores, including summed rest score (SRS), summed stress score (SSS), and summed difference score (SDS), are established prognostic markers for coronary artery disease (CAD).
- The diagnostic accuracy of these MPS parameters, particularly considering varying thresholds for myocardial ischemia, requires further elucidation in elderly populations without known CAD.
Purpose of the Study:
- To evaluate the independent diagnostic value and accuracy of MPS-derived scores (SRS, SSS, SDS) for detecting CAD in elderly individuals.
- To assess the impact of different myocardial ischemia thresholds on the diagnostic performance of MPS for CAD.
Main Methods:
- Retrospective analysis of 322 elderly individuals undergoing MPS followed by coronary angiography.
- Calculation of SRS, SSS, and SDS, with abnormal perfusion defined as SSS > 3 and ischemia as SDS ≥ 2 (mild, moderate, severe).
- Multivariate logistic regression analysis to determine the independent association of MPS parameters with CAD, adjusting for clinical variables and Framingham risk score.
Main Results:
- CAD was diagnosed in 56% of participants.
- SRS, SSS, and SDS were independently associated with CAD.
- An SSS > 3 was significantly associated with CAD (OR 2.51), while SDS ≥ 2 was not independently associated unless the threshold was raised to SDS ≥ 5 (OR 2.31).
- Higher ischemia levels correlated with increased CAD probability in patients with SSS > 3.
- Increasing ischemia thresholds improved MPS specificity but reduced sensitivity for CAD diagnosis and severity assessment.
Conclusions:
- Continuous MPS scores (SRS, SSS, SDS) and specific thresholds demonstrate independent diagnostic value and accuracy for CAD in elderly individuals.
- The diagnostic yield of coronary angiography for suspected CAD in the elderly may be enhanced by the broader application of these validated MPS parameters.
- Optimizing ischemia thresholds in MPS analysis can refine CAD detection and severity assessment.
Aims:
Myocardial perfusion and ischemia scores obtained from myocardial perfusion scintigraphy (MPS) have strong independent prognostic value in elderly individuals without known coronary artery disease (CAD). Herein we aimed to assess their independent diagnostic value and accuracy for CAD while considering different thresholds of myocardial ischemia.
Methods:
We estimated the summed rest score (SRS), summed stress score (SSS) and summed difference score (SDS) in 322 elderly individuals (mean age 72 ± 7 years, 68% men) who underwent coronary angiography following an MPS. Abnormal perfusion at stress was defined as an SSS greater than 3, and ischemia as an SDS of at least 2, and further categorized as mild (2-4), moderate (5-7) or severe (>7). Multivariate logistic regressions were used to establish the independent diagnostic value and accuracy of MPS parameters.
Results:
CAD was diagnosed in 182 individuals (56%). In multivariate analysis accounting for clinical variables associated with CAD including the Framingham risk score, both SRS [odds ratio (OR) 1.09, 95% confidence interval (CI) 1.01-1.18, P = 0.03] and SSS (OR 1.10, 95% CI 1.04-1.16, P = 0.0006) and SDS (OR 1.12, 95% CI 1.04-1.21, P = 0.003) were independently associated with CAD. An SSS greater than 3 was also independently associated with CAD (OR 2.51, 95% CI 1.43-4.39, P = 0.0013), whereas an SDS of 2 or greater was not (OR 1.62, 95% CI 0.89-2.93, P = 0.12), but only when at least 5 (OR 2.31, 95% CI 1.32-4.03, P = 0.003). The probability of CAD was proportional to the amount of myocardial ischemia in those with an SSS greater than 3, and lower and comparable in those with an SSS of at least 3 or an SSS greater than 3 with SDS of 1 or less (P = 0.19). Increasing the threshold of myocardial ischemia determined a decrease in sensitivity and increase in specificity of MPS for both diagnosis and severity of CAD.
Conclusion:
We established the diagnostic value and accuracy of continuous scores and thresholds of abnormal myocardial perfusion and ischemia previously validated in prognostic studies. Their more widespread use could potentially improve the diagnostic yield of coronary angiography in elderly individuals with suspected CAD.
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