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Adenosine single-photon emission computed tomography-derived transient ischemic dilatation and ejection fraction reserve fail to predict multivessel coronary artery disease

Driessen, Roel S.a; Raijmakers, Pieter G.b; Danad, Ibrahima; Stuijfzand, Wynand J.a; Schumacher, Stefan P.a; Lammertsma, Adriaan A.b; van Rossum, Albert C.a; van Royen, Nielsa; Underwood, S. Richardc; Knaapen, Paula

Nuclear Medicine Communications: July 2019 - Volume 40 - Issue 7 - p 773–774
doi: 10.1097/MNM.0000000000001033

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:

Received November 22, 2018

Received in revised form March 9, 2019

Accepted April 24, 2019

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