Abstract
Background
Limited data address the roles of gender, perfusion defect reversibility, and imaging position in interpretation of images acquired on an upright/supine cadmium-zinc-telluride (CZT) cardiac imaging system.
Methods and Results
From a consecutive cohort of patients imaged on an upright/supine CZT camera, 260 patients with coronary angiograms were studied. Multivariable models identified gender as a significant effect modifier for imaging variables of CAD. For males, a supine summed stress score (SSS) ≥ 3 provided high accuracy (sensitivity 70.7%, specificity 72.2%), and highest contribution to multivariable models. In females, supine SSS ≥ 2 provided the best cut-off for defect size and severity (sensitivity 90%, specificity 35.9%), but specificity was improved substantially to 53.3% with decrease in sensitivity to 80% by also requiring quantitative identification of perfusion defect reversibility in the supine position. Eight variables, accurate for predicting coronary disease, were more accurate with supine than upright imaging.
Conclusions
Perfusion defect reversibility improved specificity in female patients for detection of coronary disease compared to perfusion defect size and extent alone. Supine images provided superior accuracy for detection of coronary disease compared to upright images.
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Abbreviations
- SPECT:
-
Single-photon emission computerized tomography
- SSS:
-
Summed stress score
- Combined SSS:
-
Combined summed stress score (SSS ≥ 3 both supine and upright, or SSS ≥ 5 in either upright or supine position)
- Supine SSS:
-
Summed stress score in supine position
- SRS:
-
Summed rest score
- SDS:
-
Summed difference score
- SRP:
-
Summed rest percentage
- SSP:
-
Summed stress percentage
- QREV:
-
Total quantitative change in defect reversibility in the entire left ventricle
- QREVS:
-
QREV in the supine position
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Acknowledgement
The authors thank Marge Duke for her invaluable assistance with the data management.
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None of the above authors have any conflicts of interest.
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Funded by a Grant from the John R. Strauss Fund for Research and Education in Cardiovascular Imaging.
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Supplementary material 1 Supplemental Fig. 1 Receiver operating curves for male model 2 and female model 2 (TIFF 4841 kb)
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Athar, M.W., Waqar, F., Dwivedi, A.K. et al. Effects of gender and defect reversibility on detection of coronary disease with an upright and supine cadmium-zinc-telluride camera. J. Nucl. Cardiol. 28, 1569–1582 (2021). https://doi.org/10.1007/s12350-019-01878-7
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DOI: https://doi.org/10.1007/s12350-019-01878-7