Effect of Localization of Coronary Artery Lesions on Total Perfusion Deficit in Myocardial Perfusion Scintigraphy

Abstract

Introduction: In the present study, we analyzed patients with stable coronary artery disease (SCAD) by quantitative myocardial perfusion scintigraphy and evaluated the effect of different coronary lesion locations on total perfusion deficit (TPD).

Patients and Methods: A total of 133 consecutive patients with SCAD who underwent myocardial perfusion imaging single photon emission computed tomography (SPECT) and conventional coronary angiography according to SPECT results were included in the study. TPD was used as the automated quantification variable.

Results: Of the patients, 61 had significant coronary artery disease, and 72 had normal coronary arteries. For the normal, left anterior descending artery (LAD), circumflex artery (CX), and right coronary artery (RCA) groups, the median values were 7% vs. 11% vs. 10% vs. 9%, 4% vs. 6% vs. 7% vs. 4%, and 3% vs. 5% vs. 6% vs. 3% for stress TPD (sTPD), rest TPD (rTPD), and ischemic TPD (iTPD), respectively. There was no statistically significant difference in quantitative analysis (sTPD, rTPD, and iTPD) between the LAD, CX, and RCA groups (p> 0.05).

Conclusion: TPD obtained by quantitative analysis method can be used for all coronary artery lesion location.

Keywords

• Stable coronary artery disease,total perfusion deficit,SPECT

Miyokart Perfüzyon Sintigrafisinde Koroner Arter Lezyonlarının Lokalizasyonunun Total Perfüzyon Defekti Üzerine Etkisi

Abstract

Giriş: Bu çalışmada kantitatif miyokart perfüzyon sintigrafisi ile stabil koroner arter hastalığı olan hastaları inceledik ve farklı koroner lezyon lokasyonlarının total perfüzyon defekti üzerine olan etkisini değerlendirdik.

Hastalar ve Yöntem: Stabil koroner arter hastalığı olan miyokardiyal perfüzyon görüntüleme-SPECT yapılan ve SPECT sonuçlarına göre konvansiyonel koroner anjiyografiye alınmış 133 ardışık hasta çalışmaya alındı. Kantitatif inceleme değişkeni olarak total perfüzyon defekti (TPD) kullanıldı.

Bulgular: Atmış bir hastada anlamlı koroner arter hastalığı ve 72 hastada normal koroner arter vardı. Normal, LAD, CX ve RCA grupları için medyan değerler sTPD (sırasıyla %7, %11, %10, %10), rTPD (sırasıyla %4, %6, %7, %4,) ve iTPD ( sırasıyla %3, %5, %6, %3) idi. Kantitatif analizde (sTPD, rTPD ve iTPD) LAD, CX ve RCA grupları arasında istatistiksel olarak anlamlı fark yoktu (p> 0.05).

Sonuç: Kantitatif analiz yöntemiyle elde edilen total perfüzyon defisiti tüm koroner arter hastalığı lokalizasyonları için kullanılabilir.

Keywords

• Kararlı koroner arter hastalığı,total perfüzyon defisiti,SPECT

References

1. 1. Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging-executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol 2003;42:1318-33.
2. 2. Berman DS, Kang X, Gransar H, Gerlach J, Friedman JD, Hayes SW, et al. Quantitative assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproduciblethan expert visual analysis. J Nucl Cardiol 2009;16:45-53.
3. 3. Yoshinaga K, Matsuki T, Hashimoto A, Tsukamoto K, Nakata T, Tamaki N. Validation of automated quantitation of myocardial perfusion and fatty acid metabolism abnormalities on SPECT images. Circ J 2011;75:2187-95.
4. 4. Hachamovitch R, Berman DS, Kiat H, Bairey CN, Cohen I, Cabico A, et al. Effective risk stratification using exercise myocardial perfusion SPECT in women gender-related differences in prognostic nuclear testing. J Am Coll Cardiol 1996;28:33-44.
5. 5. Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, et al. Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation 1996;93:905-14.
6. 6. Hachamovitch R, Rozanski A, Shaw LJ, Stone GW, Thomson LE, Friedman JD, et al. Impact of ischemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical theraphy among patients undergoing stres-rest myocardial perfusion scintigraphy. Eur Heart J 2011;32:1012-24.
7. 7. Iskander S, Iskandrian AE. Risk assesment using single-photon emission computed tomographic technetium-99m sestamibi imaging. J Am Coll Cardiol 1998;32:57-62.
8. 8. Slomka PJ, Nishina H, Berman DS, Akincioglu C, Abidov A, Friedman JD, et al. Automated quantification of myocardia perfusion SPECT using simplified normal limits. J Nucl Cardiol 2005:12:66-77.

9. 9. Lin FY, Dunning AM, Narula J, Shaw LJ, Gransar H, Berman DS, et al. Impact of an automated multimodality point-of-order decision support tool on rates of appropriate testing and clinical decision making for individuals with suspected coronary artery disease: a prospective multicenter study. J Am Coll Cardiol 2013;62:308-16.
10. 10. Brown KA. Prognostic value of thallium-201 myocardial perfusion imaging. A diagnostic tool comes of age. Circulation 1991;83:363-81.
11. 11. Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998;97:535-43.
12. 12. Hachamovitch R, HayesSW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 2003;107:2900-7.
13. 13. Germano G, Kavanagh PB, Slomka PJ, Van Kriekinge SD, Pollard G, Berman DS. Quantitation in gated perfusion SPECT imaging: The Cedars-Sinai approach. J Nucl Cardiol 2007;14:433-54.
14. 14. Ficaro EP, Lee BC, Kritzman JN, Corbett JR. Corridor4DM: the Michigan method for quantitative nuclear cardiology. J Nucl Cardiol 2007;14:455-65.
15. 15. Garcia EV, Faber TL, Cooke CD, Folks RD, Chen J, Santana C. The increasing role of quantification in clinical nuclear cardiology: the Emory approach. J Nucl Cardiol 2007;14:420-32.
16. 16. Slomka P, Hung GU, Germano G, Berman DS. Novel SPECT technologies and approaches in cardiac imaging. Cardiovasc Innov Appl 2016;2:31-46.
17. 17. Sahiner I, Akdemir UO, Kocaman SA, Sahinarslan A, Timurkaynak T, Unlu M. Quantitative evaluation improves specificity of myocardial perfusion SPECT in the assessment of functionally significant intermediate coronary artery stenoses: a comparative study with fractional flow reserve measurements. Am Nucl Med 2013;27:132-9
18. 18. Holly TA, Abbott BG, Al-Mallah M, Calnon DA, Cohen MC, DiFilippo FP, et al. Single photon-emission computed tomography. J Nucl Cardiol 2010;17:941-73.
19. 19. Imbert L, Poussier S, Franken PR, Songy B, Verger A, Morel O, et al. Compared performance of high-sensitivity cameras dedicated to myocardial perfusion SPECT: a comprehensive analysis of phantom and human images. J Nucl Med 2012;53:1897-903.
20. 20. Verberne HJ, Acampa W, Anagnostopoulos C. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging 2015;42:1929-40.
21. 21. Xu Y, Hayes S, Ali I, Ruddy TD, Wells RG, Berman DS, et al. Automatic and visual reproducibility of perfusion and function measures for myocardial perfusion SPECT. J Nucl Cardiol 2010;17:1050-7.
22. 22. Arsanjani R, Xu Y, Hayes SW. Comparison of fully automated computer analysis and visual scoring for detection of coronary artery disease from myocardial perfusion SPECT in a large population. J Nucl Med 2013;54:221-8.
23. 23. Nakazato R, Tamarappoo BK, Kang X. Quantitative upright--supine high-speed spect myocardial perfusion ımaging for detection of coronary artery disease: correlation with ınvasive coronary angiography. J Nucl Med 2010;51:1724-31.
24. 24. Slomka PJ, Nishina H, Berman DS, Kang X, Friedman JD, Hayes SW, et al. Automatic quantification of myocardial perfusion stress-rest change: a new measure of ischemia. J Nucl Med 2004;45:183-91.
25. 25. Prasad M, Slomka PJ, Fish M, Kavanagh P, Gerlach J, Hayes S, et al. Improved quantification and normal limits for myocardial perfusion stress-rest change. J Nucl Med 2010;51:204-9.
26. 26. Havel M, Kolacek M, Kaminek M. Myocardial perfusion imaging parameters: IQ- SPECTand conventional spect system comparison. Hell J Nucl Med 2014;17:200-3.
27. 27. Schumacher SP, Leipsic JA, Min JK, Knuuti J, Lammertsma AA, van Rossum AC, et al. Automated SPECT analysis compared with expert visual scoring for the detection of FFR-definedcoronary artery disease. Eur J Nucl Med Mol Imaging 2018;45:1091-100.