Comparison of Tc-99m sestamibi SPECT with fractional flow reserve in patients with intermediate coronary artery stenoses View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2005-11

AUTHORS

Marcus Hacker, Johannes Rieber, Rupert Schmid, Christian LaFougere, Andreas Tausig, Karl Theisen, Volker Klaus, Reinhold Tiling

ABSTRACT

BackgroundMyocardial single photon emission computed tomography (SPECT) is an established noninvasive method for the assessment of the functional significance of coronary artery stenoses. Intracoronary pressure measurements to determine fractional flow reserve (FFR) are increasingly performed during coronary angiography whenever an immediate decision regarding possible intervention is required. We hypothesized that the regional summed difference score (SDSr), reflecting reversible perfusion defects in the myocardial supply area of the FFR target vessel, would be the best predictor of an abnormal FFR in patients without prior myocardial infarction. Otherwise, a regional summed stress score (SSSr) should be the best predictor of an abnormal FFR in patients with prior myocardial infarction for different patient subgroups with coronary artery disease.Methods and ResultsIn this study 50 patients (mean age, 65 ± 9.1 years; 18 women) with coronary artery disease and a 50% to 75% coronary stenosis (target vessel) were prospectively investigated. Dobutamine myocardial SPECT was performed as a single-day stress/rest protocol by use of technetium 99m sestamibi. For image interpretation, semiquantitative analysis was conducted by calculating SSSr and SDSr. Within 8 (±14.9) days, coronary angiography was performed and FFR was calculated by use of a pressure wire (normal FFR, >0.75). The mean FFR of all patients was 0.78 ± 0.14. Of 50 patients, 17 had an FFR lower than 0.75 in the target vessel. Receiver operating characteristic analysis identified an SDSr of 1 or greater and an SSSr of 3 or greater as the best threshold values for predicting ischemic FFR. Sensitivity, specificity, and negative and positive predictive values of SDSr and SSSr for the detection of FFR values lower than 0.75 in the target vessel were 80%, 76%, 53%, and 92%, respectively, and 70%, 93%, 78%, and 90%, respectively, in patients without prior myocardial infarction and 57%, 50%, 67%, and 40%, respectively, and 100%, 50%, 78%, and 100%, respectively, in patients with prior myocardial infarction. Weak correlation was found between the single values of FFR with both SDSr and SSSr for the different patient subgroups.ConclusionAmong the dobutamine myocardial scintigraphy variables studied, SDSr was the best predictor of an abnormal FFR (cutoff value of 0.75) in patients without prior myocardial infarction. As assumed, SSSr was the best predictor of an abnormal FFR in patients with prior myocardial infarction in the target region. More... »

PAGES

645-654

Identifiers

URI

http://scigraph.springernature.com/pub.10.1016/j.nuclcard.2005.07.006

DOI

http://dx.doi.org/10.1016/j.nuclcard.2005.07.006

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1053254741

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/16344226


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29 schema:description BackgroundMyocardial single photon emission computed tomography (SPECT) is an established noninvasive method for the assessment of the functional significance of coronary artery stenoses. Intracoronary pressure measurements to determine fractional flow reserve (FFR) are increasingly performed during coronary angiography whenever an immediate decision regarding possible intervention is required. We hypothesized that the regional summed difference score (SDSr), reflecting reversible perfusion defects in the myocardial supply area of the FFR target vessel, would be the best predictor of an abnormal FFR in patients without prior myocardial infarction. Otherwise, a regional summed stress score (SSSr) should be the best predictor of an abnormal FFR in patients with prior myocardial infarction for different patient subgroups with coronary artery disease.Methods and ResultsIn this study 50 patients (mean age, 65 ± 9.1 years; 18 women) with coronary artery disease and a 50% to 75% coronary stenosis (target vessel) were prospectively investigated. Dobutamine myocardial SPECT was performed as a single-day stress/rest protocol by use of technetium 99m sestamibi. For image interpretation, semiquantitative analysis was conducted by calculating SSSr and SDSr. Within 8 (±14.9) days, coronary angiography was performed and FFR was calculated by use of a pressure wire (normal FFR, >0.75). The mean FFR of all patients was 0.78 ± 0.14. Of 50 patients, 17 had an FFR lower than 0.75 in the target vessel. Receiver operating characteristic analysis identified an SDSr of 1 or greater and an SSSr of 3 or greater as the best threshold values for predicting ischemic FFR. Sensitivity, specificity, and negative and positive predictive values of SDSr and SSSr for the detection of FFR values lower than 0.75 in the target vessel were 80%, 76%, 53%, and 92%, respectively, and 70%, 93%, 78%, and 90%, respectively, in patients without prior myocardial infarction and 57%, 50%, 67%, and 40%, respectively, and 100%, 50%, 78%, and 100%, respectively, in patients with prior myocardial infarction. Weak correlation was found between the single values of FFR with both SDSr and SSSr for the different patient subgroups.ConclusionAmong the dobutamine myocardial scintigraphy variables studied, SDSr was the best predictor of an abnormal FFR (cutoff value of 0.75) in patients without prior myocardial infarction. As assumed, SSSr was the best predictor of an abnormal FFR in patients with prior myocardial infarction in the target region.
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35 schema:keywords Comparison of Tc
36 ConclusionAmong
37 FFR values
38 ResultsIn
39 SDSR
40 SPECT
41 Tc
42 abnormal fractional flow reserve
43 analysis
44 angiography
45 area
46 artery
47 artery disease
48 assessment
49 best predictor
50 best threshold value
51 characteristic analysis
52 comparison
53 coronary angiography
54 coronary artery
55 coronary artery disease
56 coronary stenosis
57 correlation
58 days
59 decisions
60 defects
61 detection
62 difference scores
63 different patient subgroups
64 disease
65 emission
66 flow reserve
67 fractional flow reserve
68 functional significance
69 image interpretation
70 immediate decision
71 infarction
72 intermediate coronary artery
73 interpretation
74 intervention
75 intracoronary pressure measurements
76 ischemic fractional flow reserve
77 mean fractional flow reserve
78 measurements
79 method
80 myocardial SPECT
81 myocardial infarction
82 noninvasive method
83 patient subgroups
84 patients
85 perfusion defects
86 photon emission
87 positive predictive value
88 possible interventions
89 predictive value
90 predictors
91 pressure measurements
92 pressure wire
93 prior myocardial infarction
94 protocol
95 receiver
96 region
97 reserves
98 rest protocol
99 reversible perfusion defects
100 scores
101 semiquantitative analysis
102 sensitivity
103 sestamibi
104 significance
105 single photon emission
106 single value
107 specificity
108 stenosis
109 stress scores
110 study 50 patients
111 subgroups
112 summed stress score
113 supply area
114 target region
115 target vessel
116 technetium
117 threshold value
118 tomography
119 use
120 use of technetium
121 values
122 variables
123 vessels
124 weak correlation
125 wire
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