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The value of myocardial perfusion CZT-SPECT in the assessment of coronary microvascular dysfunction in INOCA

Mengyu Fei1, Federico Caobelli2, Hengbin Zhang3

  • 1Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People's Republic of China.

The International Journal of Cardiovascular Imaging
|July 8, 2026
PubMed

Insights

This study found that CZT-SPECT-derived global stress myocardial blood flow (sMBF) and myocardial flow reserve (MFR) offer modest diagnostic accuracy for identifying coronary microvascular dysfunction (CMD) in patients with ischemia and non-obstructive coronary artery disease (INOCA). This non-invasive method may aid in diagnosing CMD.

Area of Science:

  • Cardiovascular Imaging
  • Nuclear Cardiology
  • Diagnostic Accuracy Studies

Background:

  • Previous research highlighted the prognostic value of CZT-SPECT-derived sMBF and MFR in INOCA patients.
  • The diagnostic utility and optimal cut-off values for identifying coronary microvascular dysfunction (CMD) using these parameters remained undetermined.

Purpose of the Study:

  • To evaluate the diagnostic value of CZT-SPECT-derived sMBF and MFR for detecting CMD in INOCA patients.
  • To determine optimal cut-off values for these parameters in diagnosing CMD.

Main Methods:

  • Prospective recruitment of 56 INOCA patients undergoing CZT-SPECT and coronary angiography-derived index of microcirculatory resistance (caIMR).
  • CMD was defined as caIMR > 25 U.
  • Statistical analysis included Bonferroni correction and diagnostic accuracy assessment using AUC.

Main Results:

  • CMD was present in 75% of INOCA patients (42/56) based on caIMR.
  • Global MFR was significantly lower in the CMD group (p < 0.01).
  • Optimal cut-offs: global sMBF ≤ 3.8 mL/min/g (AUC=0.68) and global MFR ≤ 2.9 (AUC=0.80).

Conclusions:

  • CZT-SPECT-derived global sMBF and MFR demonstrate modest diagnostic accuracy for CMD in INOCA patients.
  • This non-invasive approach shows potential for supporting CMD identification and guiding clinical decisions.
Abstract

Keywords:
CMDCZT-SPECTINOCAMFRcaIMRsMBF

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