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Clinical usefulness of myocardial scintigraphy in patients with vasospastic angina

Shozo Sueda1

  • 1The Department of Cardiology, Ehime Prefectual Niihama Hospital, Hongou 3 choume 1-1, Niihama, Ehime Prefecture 792-0042, Japan.

Journal of Cardiology
|December 22, 2019
PubMed

Insights

Myocardial scintigraphy using thallium (Tl) or BMIPP tracers shows moderate sensitivity and specificity for diagnosing vasospastic angina (VSA). These methods can serve as valuable supplementary tools for VSA diagnosis.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Diagnostic Imaging

Background:

  • Japanese guidelines classify myocardial scintigraphy for vasospastic angina (VSA) diagnosis (Class IIb).
  • Caucasian guidelines lack specific classifications for cardiac scintigraphy in VSA diagnosis.
  • Clinical utility of various myocardial scintigraphy tracers for VSA requires clarification.

Purpose of the Study:

  • To evaluate the diagnostic performance (sensitivity and specificity) of different myocardial scintigraphy tracers for vasospastic angina (VSA).
  • To compare the effectiveness of various radiotracers in identifying coronary artery spasm.

Main Methods:

  • Systematic review of 136 PubMed-indexed studies on myocardial scintigraphy for VSA (1980-2018).
  • Analysis of 88 selected papers focusing on thallium-201 (Tl), 123I-BMIPP, 123I-MIBG, 99mTc-sestamibi (MIBI), and tetrofosmin.
  • Calculation of sensitivity and specificity for each scintigraphic tracer.

Main Results:

  • Thallium (Tl), BMIPP, and MIBG scintigraphy demonstrated diagnostic utility for VSA with sensitivities of 57-73% and specificities of 55-83%.
  • Left circumflex artery involvement showed significantly lower sensitivity.
  • BMIPP imaging may aid in monitoring the clinical course of VSA.
  • Abnormal scintigraphic findings do not always correlate with coronary artery spasm-induced ischemic memory.

Conclusions:

  • Myocardial scintigraphy with Tl or BMIPP is recommended as a supplementary diagnostic tool for VSA.
  • Current cardiological practice often omits hyperventilation tests and MIBG scintigraphy for coronary spasm diagnosis.
  • Clinicians should consider Tl or BMIPP myocardial scintigraphy for VSA diagnosis in contemporary practice.
Abstract

Keywords:
Cardiac scintigraphyCoronary spasmDiagnosisVasospastic angina

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