Next to myocardial perfusion, single-photon emission computed tomography (SPECT) also allows for the assessment of nonperfusion parameters such as transient ischemic dilatation (TID) and a reduction of ejection fraction (EF) with stress imaging. This study aimed to evaluate the diagnostic value of TID and EF reserve for the detection of significant multivessel coronary artery disease (CAD). A total of 206 patients with suspected stable CAD prospectively underwent gated stress-rest 99mTc-tetrofosmin SPECT and invasive coronary angiography with routine fractional flow reserve (FFR) measurements, irrespective of imaging results. Left ventricular volumes, TID, and EF reserve were assessed and compared with FFR-defined severity of CAD. According to FFR, 92 (45%) patients had significant CAD, whereas 25 (12%) showed 2-vessel disease (VD) and 22 (11%) showed 3-VD. With an increasing extent of CAD, TID values and EF reserve did not change significantly (P=0.07 and 0.42 for trend, respectively). Conversely, absolute left ventricular volumes and EF differed significantly among groups of CAD severity (P<0.01 for all trends). SPECT-derived TID and EF reserve did not differ between patients with high-risk CAD (3-VD) and low risk or no significant CAD. Therefore, the present results advocate exerting caution when using these ancillary findings in clinical practice.
Departments of aCardiology
bRadiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
cDepartment of Nuclear Medicine, Royal Brompton Hospital, London, UK
Correspondence to Paul Knaapen, MD, PhD, Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands Tel: +31 204 442 441; fax: +31 204 442 446; e-mail: firstname.lastname@example.org
Received November 22, 2018
Received in revised form March 9, 2019
Accepted April 24, 2019