Impact of cardiac size on diagnostic performance of single-photon emission computed tomography myocardial perfusion...

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Performance

Background:

• Single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) is widely used for diagnosing coronary artery disease (CAD).
• Observed variations in SPECT MPI diagnostic performance suggest underlying factors influencing accuracy.
• The specific impact of cardiac size on SPECT MPI performance has not been well characterized.

Purpose of the Study:

• To assess if low left ventricular volume affects SPECT MPI's ability to detect obstructive CAD.
• To investigate the interaction between cardiac size, age, and sex in SPECT MPI performance.
• To identify patient characteristics associated with reduced diagnostic accuracy in SPECT MPI.

Main Methods:

• Analysis of 2066 patients without known CAD undergoing SPECT MPI and coronary angiography.
• Evaluation of quantitative and visual SPECT MPI assessments based on cardiac size (end-diastolic volume), age, and sex.
• Receiver-operating characteristic curve (AUC) analyses to compare diagnostic performance across different patient subgroups.

Main Results:

• SPECT MPI performance was significantly decreased in patients with low end-diastolic volume (EDV) compared to those without.
• Elderly patients showed decreased SPECT MPI performance compared to younger patients.
• Reduced accuracy was primarily observed in males with low EDV, with significant decreases in AUC, sensitivity, specificity, and negative predictive value.

Conclusions:

• Small cardiac size negatively impacts CAD detection using SPECT MPI.
• The diagnostic performance of SPECT MPI is most notably affected in elderly and male patients with smaller cardiac volumes.
• These findings underscore the importance of considering cardiac size, age, and sex for accurate SPECT MPI interpretation.