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Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease

  • Original Articles
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

There have been limited data regarding the value of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for the detection of left main coronary artery disease (CAD).

Methods and Results

We studied 101 patients with angiographic left main CAD (≥50% stenosis) and no prior myocardial infarction or coronary revascularization who underwent gated exercise or adenosine stress technetium 99m sestamibi SPECT MPI. By perfusion assessment alone, high-risk disease with moderate to severe defects (>10% myocardium at stress) was identified in only 56% of patients visually and 59% quantitatively. Absence of significant perfusion defect (≥5% myocardium) was seen in 13% of patients visually and 15% quantitatively. However, by combining visual perfusion data and nonperfusion variables, especially transient ischemic dilation, 83% of patients were identified as high risk.

Conclusions

The findings of this study demonstrate that assessment of perfusion data alone by visual or quantitative SPECT MPI analysis underestimates the magnitude of left main CAD. The combination of perfusion and nonperfusion abnormalities on gated MPI identifies high risk in most patients with left main CAD.

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Authors and Affiliations

  1. Department of Imaging (Division of Nuclear Medicine), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Room 1258, 90048, Los Angeles, CA

    Daniel S. Berman, Xingping Kang, Piotr J. Slomka, James Gerlach, Ling de Yang, Sean W. Hayes, John D. Friedman, Louise E. J. Thomson & Guido Germano

  2. Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, Calif.

    Daniel S. Berman, Xingping Kang, Piotr J. Slomka, James Gerlach, Ling de Yang, Sean W. Hayes, John D. Friedman, Louise E. J. Thomson & Guido Germano

  3. CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif.

    Daniel S. Berman, Xingping Kang, Piotr J. Slomka, James Gerlach, Ling de Yang, Sean W. Hayes, John D. Friedman, Louise E. J. Thomson & Guido Germano

  4. Department of Medicine, School of Medicine, University of California at Los Angeles, Los Angeles, Calif.

    Daniel S. Berman, Piotr J. Slomka, Sean W. Hayes, John D. Friedman & Guido Germano

Authors
  1. Daniel S. Berman
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  2. Xingping Kang
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  3. Piotr J. Slomka
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  4. James Gerlach
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  5. Ling de Yang
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  6. Sean W. Hayes
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  7. John D. Friedman
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  8. Louise E. J. Thomson
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  9. Guido Germano
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Corresponding author

Correspondence to Daniel S. Berman.

Additional information

This study was presented in part at the American College of Cardiology 56th Annual Scientific Session, March 24–27, 2007, New Orleans, La.

This work was supported in part by grants from Bristol-Myers Squibb Medical Imaging, Billerica, Mass, and Astellas, Deerfield, Ill.

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Berman, D.S., Kang, X., Slomka, P.J. et al. Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease. J Nucl Cardiol 14, 521–528 (2007). https://doi.org/10.1016/j.nuclcard.2007.05.008

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  • DOI: https://doi.org/10.1016/j.nuclcard.2007.05.008

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