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Clinical usefulness of quantification of myocardial blood flow and flow reserve using CZT-SPECT for detecting coronary artery disease in patients with normal stress perfusion imaging.

Abstract：

BACKGROUND:Relative myocardial perfusion imaging can misdiagnose "balanced" ischemia caused by coronary artery disease (CAD). We assessed the feasibility of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) using dynamic single-photon emission computed tomography (SPECT) with a cadmium-zinc-telluride (CZT) camera for estimating underlying CAD in patients with normal stress myocardial perfusion SPECT (MPS). METHODS:125 patients with normal stress MPS (summed stress score ≤3) were enrolled. All patients underwent coronary angiography (CAG) and stress/rest 201Tl dynamic SPECT for MBF and MPR calculation. The diagnostic accuracy of both these quantitative values and other clinical risk factors for predicting occult CAD were validated by CAG. RESULTS:MPR was 2.85 in patients with no CAD, 2.47 with 1-, 1.98 with 2-, and 1.76 with 3-vessel CAD. The patient's age, morbidity of diabetes mellitus (DM), chronic kidney disease (CKD), stress MBF, and MPR were significantly associated with the presence of CAD (age, p=0.02; DM, p=0.005; CKD, p=0.005; creatinine level, p= 0.012, stress MBF, p=0.019, and MPR, p<0.001). Independent predictors in the multivariate regression analysis were as follows: DM, p=0.011, CKD, p=0.028, and MPR, p<0.001. The combined index was calculated from three independent predictors. Area under the receiver operating characteristic curve was 0.75 for MPR and 0.81 for the combined index. To identify CAD, sensitivity, and specificity for MPR were 77% and 66%, and for the combined index they were 79% and 66%, respectively. CONCLUSION:Quantification of MPR and MBF using dynamic SPECT with a CZT camera can be useful to identify balanced ischemia caused by occult CAD in patients with normal stress MPS findings.

journal_name

J Cardiol

journal_title

Journal of cardiology

authors

Shiraishi S,Tsuda N,Sakamoto F,Ogasawara K,Tomiguchi S,Tsujita K,Yamashita Y

doi

10.1016/j.jjcc.2019.09.006

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

400-409

issue

4

eissn

0914-5087

issn

1876-4738

pii

S0914-5087(19)30296-5

journal_volume

75

pub_type

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