Quantitative stress radionuclide myocardial perfusion imaging can indicate significant coronary artery  stenosis

Taerakul T; Boonyaleepan A; Sisai S; Werawatganon T

Authors

Taerakul T Department of Radiology, Rajavithi Hospital, College of Medicine, Rangsit University, Thailand
Boonyaleepan A Department of Radiology, Rajavithi Hospital, College of Medicine, Rangsit University, Thaialand
Sisai S Department of Radiology, Rajavithi Hospital, College of Medicine, Rangsit University, Thailand
Werawatganon T Department of Anaesthesiology, Faculty of Medicine, Chulalongkorn University, Thailand

Keywords:

coronary artery disease, radionuclide myocardial perfusion imaging, quantitative analysis

Abstract

Objective The objective of this study was to evaluate the effectiveness of quantitative assessment of
radionuclide myocardial perfusion imaging in indicating significant coronary artery stenosis.

Methods Seven hundred and twenty patients with suspicion of coronary artery disease were retrospectively identified. All had undergone cardiac catheterization within a 6-month period after having had a one-day pharmacologic stress radionuclide myocardial perfusion scan. Important parameters analyzed included myocardial perfusion, wall motion, wall thickening severity scores of 3 coronary artery territories and left ventricular ejection fraction values. These parameters were subsequently compared with currently the gold standard for cardiac catheterization.

Results Binary logistic regression analysis found that patients who had significant coronary artery stenosis had significantly higher values in all quantitative parameters (mean severity scores in myocardial perfusion, wall motion, wall thickening in most of the 3 coronary artery territories) than those in the non-significant group (p<0.05) with the exception of the wall motion severity score of the left circumflex artery. Similarly, patients with higher perfusion severity scores had a higher probability of significant coronary artery stenosis in all three coronary arteries.

Conclusion Quantitative parameters obtained from stress radionuclide myocardial perfusion imaging can indicate significant coronary artery stenosis in all three main coronary arteries at a level comparable with that of cardiac catheterization which is currently the gold standard method but it is superior to cardiac catherization due to less invasive and less expensive. Higher perfusion severity scores indicate a higher probability of significant coronary artery stenosis.

References

1. Cardiac system. In: Ziessman HA, Janis P. O’Malley, James H, Thrall, editors. Nuclear medicine: the requisites in radiology. 3rd ed. Philadelphia: Elsevier Mosby; 2006. p. 450-507.
2. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. Heart disease and stroke statistics-2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117:25-146.
3. Sousa P. Comment on “Cardiovascular disease in Europe 2014: epidemiological update”. Rev Port Cardiol 2015;34:381-2.
4. Wolk MJ, Bailey SR, Doherty JU, Douglas PS, Hendel RC, Kramer CM, et al. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Card Fail. 2014;20:65-90.
5. Bell MR, Bittl JA. Management of significant proximal left andterior descending coronary artery disease. In: Christopher P, Cutlip D, editors. UpToDate. Waltham, MA: UpToDate Inc. [cite 2017 November 19]. Available from: http://www.uptodate.com
6. Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA, Sawada SG, American Society of Echocardiography. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr. 2007;20:1021-41.
7. Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardiol. 2011;57:1126-66.
8. Garber AM, Solomon NA. Cost-effectiveness of alternative test strategies for the diagnosis of coronary
artery disease. Ann Intern Med. 1999;130:719-28.
9. Cardiovascular system. In: Mettler FA, Milton J. Guiberteau, editors. Essential of nuclear medicine. 6th ed. Philadelphia: Elsevier Saunders; 2012. p. 131-94.
10. Massie BM, Botvinick EH, Brundage BH. Correlation of thallium-201 scintigrams with coronary anatomy: Factors affecting region by region sensitivity. Am J Cardiol. 1979; 44:616-22.
11. Rigo P, Bailey IK, Griffith LSC, Pitt B, Burow RD, Wagner HN, Becker LC. Value and limitations of segmental analysis of stress thallium myocardial imaging for localization of coronary artery disease. Circulation. 1980;61:973-81.
12. Dash H, Massie BM, Botvinick EH, Brundage BH. The noninvasive identification of left main and three-vessel coronary artery disease by myocardial stress perfusion scintigraphy and treadmill exercise electrocardiography. Circulation. 1979;60:276-84.
13. McKillop JH, Murray RG, Turner JG, Bessent BG, Lorimer AR, Greig WR. Can the extent of coronary artery disease be indicated from thallium-201 myocardial images? J Nucl Med. 1979;20:715-9.
14. Lenaers A, Block P, Thiel EV, Lebedelle M, Becquevort P, Erbsmann F, et al. Segmental analysis of Tl-201 stress myocardial scintigraphy. J Nucl Med. 1977;18:509-16.
15. Slomka P, Xu Y, Berman D, Germano G. Quantitative analysis of perfusion studies: Strengths and pitfalls. J Nucl Cardiol. 2012;19:338-46.
16. Slomka PJ, Nishina H, Berman DS, Akincioglu C, Abidov A, Friedman JD, et al. Automated quantification of myocardial perfusion SPECT using simplified normal limits. J Nucl Cardiol. 2005;12:66-77.
17. Arsanjani R, Xu Y, Hayes SW, Fish M, Lemley M, Gerlach J, et al. 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.
18. Germano G, Kavanagh PB, Su HT, Mazzanti M, Kiat H, Hachamovitch R, et al. Automatic reorientation of three-dimensional, transaxial myocardial perfusion SPECT images. J Nucl Med. 1995;36:1107-14.
19. Faber TL, Cooke CD, Folks RD, Vansant JP, Nichols KJ, DePuey EG, et al. Left ventricular function and perfusion from gated SPECT perfusion images: an integrated method. J Nucl Med. 1999;40:650-9.
20. 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.
21. 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 reproducible than expert visual analysis. J Nucl Cardiol. 2009;16:45-53.
22. Leslie WD, Tully SA, Yogendran MS, Ward LM, Nour KA, Metge CJ. Prognostic value of automated quantification of 99mTc-sestamibi myocardial perfusion imaging. J Nucl Med. 2005;46:204-11.
23. Ather S, Iqbal F, Gulotta J, Aljaroudi W, Heo J, Iskandrian AE, et al. Comparison of three commercially available softwares for measuring left ventricular perfusion and function by gated SPECT myocardial perfusion imaging. J Nucl Cardiol. 2014;21:673-81.