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Comparative analysis between myocardial perfusion reserve and maximal ischemia score at single photon emission computed tomography with new-generation cadmium-zinc-telluride cameras

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Whether estimates of myocardial perfusion reserve (MPR) stemming from new-generation cadmium-zinc-telluride (CZT) cameras are accurate remains unclear.

Methods

We queried our institutional database for patients undergoing MPR with CZT cameras. The primary goal was appraising the incremental diagnostic yield of MPR on top or at odds of maximal ischemia score (MIS).

Results

A total of 66 subjects were included. When distinguishing patients according to normal vs abnormal MPR (cut-off 2.1 mL/min/g) and normal vs abnormal MIS, 4 groups could be identified: 12 (18.1%) individuals with normal MPR and MIS, 12 (18.1%) with normal MPR and abnormal MIS, 16 (24.2%) with abnormal MPR and normal MIS, and 26 (39.4%) with abnormal MPR and MIS. MIS was significantly associated with several baseline features, whereas MPR did not. There was no significant association between MPR and MIS, nor with regional perfusion. Clinical outcomes were uncommon and not significantly associated with MPR or MIS, whereas angiographically significant coronary artery disease (CAD) was associated solely with MIS (P < 0.05), and not with MPR.

Conclusions

There is limited agreement between CZT-derived MPR and baseline risk, perfusion and angiography results. Whether such discrepancies may still prove incrementally beneficial for the diagnosis or prognosis of CAD remains unclear.

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Abbreviations

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

CZT:

Cadmium-zinc-telluride

FS:

Final score

IHD:

Ischemic heart disease

MBF:

Myocardial blood flow

MIS:

Maximal ischemia score

MPI:

Myocardial perfusion imaging

MPR:

Myocardial perfusion reserve

PCI:

Percutaneous coronary intervention

PET:

Positron emission tomography

SPECT:

Single photon emission computed tomography

VRI:

Vessel-related ischemia

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Acknowledgement

This work was supported by Replycare, Rome, Italy. Francesco Nudi, Alessandro Nudi, Giandomenico Neri, Enrica Procaccini, and Orazio Schilllaci have nothing to disclose. Giuseppe Biondi-Zoccai has consulted for Abbott Vascular and Bayer.

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Authors and Affiliations

  1. Service of Hybrid Cardio Imaging, Madonna della Fiducia Clinic, Via Giuseppe Mantellini 3, 00179, Rome, Italy

    Francesco Nudi MD, Alessandro Nudi MD, Giandomenico Neri MD & Enrica Procaccini MD

  2. Replycare, Rome, Italy

    Francesco Nudi MD

  3. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy

    Giuseppe Biondi-Zoccai MD, MStat

  4. Mediterranea Cardiocentro, Naples, Italy

    Giuseppe Biondi-Zoccai MD, MStat

  5. Ostia Radiologica, Rome, Italy

    Giandomenico Neri MD & Enrica Procaccini MD

  6. Department of Nuclear Medicine, Tor Vergata University, Rome, Italy

    Orazio Schilllaci MD

  7. IRCCS Neuromed, Pozzilli, Italy

    Orazio Schilllaci MD

Authors
  1. Francesco Nudi MD
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  2. Giuseppe Biondi-Zoccai MD, MStat
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  3. Alessandro Nudi MD
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  4. Giandomenico Neri MD
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  5. Enrica Procaccini MD
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  6. Orazio Schilllaci MD
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Correspondence to Francesco Nudi MD.

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Nudi, F., Biondi-Zoccai, G., Nudi, A. et al. Comparative analysis between myocardial perfusion reserve and maximal ischemia score at single photon emission computed tomography with new-generation cadmium-zinc-telluride cameras. J. Nucl. Cardiol. 28, 1072–1084 (2021). https://doi.org/10.1007/s12350-019-01764-2

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