Usefulness of hemodynamic changes during adenosine infusion in predicting the diagnostic accuracy of adenosine technetium-99m sestamibi single-photon emission computed tomography (SPECT)
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A M Amanullah1, D S Berman, H Kiat
1Department of Medicine, Cedars-Sinai Medical Center, the CSMC Burns and Allen Research Institute, University of California--Los Angeles School of Medicine, 90048, USA.
Insights
Adenosine myocardial perfusion SPECT accurately detects coronary artery disease (CAD) even without significant hemodynamic changes. This nuclear cardiology technique maintains high diagnostic accuracy regardless of peripheral responses to adenosine stress.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) diagnosis often relies on stress testing.
- Adenosine myocardial perfusion single-photon emission computed tomography (SPECT) is a key diagnostic tool.
- The impact of absent peripheral hemodynamic changes on SPECT accuracy is not well understood.
Purpose of the Study:
- To evaluate the diagnostic accuracy of adenosine technetium (Tc)-99m sestamibi myocardial perfusion SPECT.
- To assess the correlation between hemodynamic responses and perfusion defects in patients undergoing SPECT.
- To determine if SPECT accuracy is affected by the absence of significant peripheral hemodynamic changes during adenosine stress.
Main Methods:
- 222 patients without prior myocardial infarction or revascularization underwent adenosine Tc-99m sestamibi SPECT and cardiac catheterization.
- SPECT images were analyzed semiquantitatively using a 20-segment scoring system.
- Patients were categorized based on heart rate and blood pressure changes during adenosine stress.
Main Results:
- Adenosine Tc-99m sestamibi SPECT demonstrated high overall diagnostic accuracy for significant CAD: 93% sensitivity, 73% specificity, and 88% predictive accuracy.
- Diagnostic accuracy, prevalence of multivessel CAD, and extent of perfusion abnormalities were similar across all hemodynamic response categories.
- No significant difference in diagnostic performance was observed between patients with and without peripheral hemodynamic evidence of adenosine effect.
Conclusions:
- Adenosine Tc-99m sestamibi SPECT is a highly accurate method for detecting coronary artery disease.
- The diagnostic performance of adenosine SPECT is not compromised by the lack of significant peripheral hemodynamic changes.
- This nuclear cardiology technique provides reliable CAD detection irrespective of the patient's hemodynamic response to adenosine stress.
Abstract:
Whether adenosine myocardial perfusion single-photon emission computed tomography (SPECT) remains accurate for detecting coronary artery disease (CAD) in the absence of peripheral hemodynamic changes is unknown. To assess the hemodynamic correlates of perfusion defects, we studied 222 consecutive patients (age 71 +/- 11 years) without prior myocardial infarction or revascularization who underwent adenosine technetium (Tc)-99m sestamibi myocardial perfusion SPECT and cardiac catheterization within 6 months of adenosine study. The SPECT protocol used separate acquisition of rest thallium-201 and adenosine Tc-99m sestamibi, which was semiquantitatively analyzed in 20 segments with a visual 5-point scoring system (0 = normal, 4 = absent uptake). The overall sensitivity, specificity, and predictive accuracy of adenosine Tc-99m sestamibi SPECT for detecting significant CAD were 93% (159 of 171), 73% (37 of 51), and 88% (196 of 222), respectively. The study population was grouped into 6 categories as a function of peripheral hemodynamic changes: (1) increase in heart rate by < or = 10 beats/min (n = 135); (2) increase in heart rate by > 10 beats/min (n = 87); (3) decrease in systolic blood pressure by < or = 10 mm Hg (n = 108); (4) decrease in systolic blood pressure by > 10 mm Hg (n = 114); (5) increase in heart rate by < or = 10 beats/min and decrease in systolic blood pressure by < or = 10 mm Hg (n = 72); and (6) increase in heart rate by > 10 beats/min or decrease in systolic blood pressure by > 10 mm Hg (n = 150). The sensitivity, specificity, and predictive accuracy of adenosine sestamibi SPECT were similar in all 6 categories. The prevalence of left main or multivessel CAD and extent of scan abnormality were also similar among all groups. Thus, the diagnostic accuracy of adenosine Tc-99m sestamibi SPECT is high in patients with or without peripheral hemodynamic evidence of adenosine effect.