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Regional CZT myocardial perfusion reserve for the detection of territories with simultaneously impaired CFR and IMR in patients without obstructive coronary artery disease: a pilot study

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Objectives

To assess the diagnostic performances of CZT myocardial perfusion reserve (MPR) for the detection of territories with simultaneous impaired coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients without obstructive coronary artery disease.

Methods

Patients were prospectively included before being referred for coronary angiography. All patients underwent CZT MPR before invasive coronary angiography (ICA) and coronary physiology assessment. Rest and dipyridamole-induced stress myocardial blood flow (MBF) and MPR were quantified using 99mTc-SestaMIBI and a CZT camera. Fractional flow reserve (FFR), Thermodilution CFR, and IMR were assessed during ICA.

Results

Between December 2016 and July 2019, 36 patients were included. 25/36 patients presented no obstructive coronary artery disease. A complete functional assessment was performed in 32 arteries. No territory presented a significant ischemia on CZT myocardial perfusion imaging. A moderate yet significant correlation was observed between regional CZT MPR and CFR (r = 0.4, P = .03). Sensitivity, specificity, positive and negative predictive value, and accuracy of regional CZT MPR versus the composite invasive criterion (impaired CFR and IMR) were 87 [47% to 99%], 92% [73% to 99%], 78% [47% to 93%], 96% [78% to 99%], and 91% [75% to 98%], respectively. All territories with a regional CZT MPR ≤ 1.8 showed a CFR < 2. Regional CZT MPR values were significantly higher in arteries with CFR ≥ 2 and IMR < 25 (negative composite criterion, n = 14) than in those with CFR < 2 and IMR ≥ 25 (2.6 [2.1 to 3.6] versus 1.6 [1.2 to 1.8]), P < .01).

Conclusion

Regional CZT MPR presented excellent diagnostic performances for the detection of territories with simultaneously impaired CFR and IMR reflecting a very high cardiovascular risk in patients without obstructive coronary artery disease.

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Abbreviations

CMVD:

Coronary microvascular dysfunction

CFR:

Coronary flow reserve

MPR:

Myocardial perfusion reserve

FFR:

Fractional flow reserve

IMR:

Index of microcirculatory resistance

ICA:

Invasive coronary angiography

TAC:

Time activity curve

MBF:

Myocardial blood flow

QCA:

Quantitative coronary angiography

ICC:

Intraclass correlation coefficient

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Acknowledgments

Authors are grateful to Mr Capecci Philippe and Mrs Guellec Isabelle who contributed to initiate myocardial perfusion reserve quantification in CHU Grenoble Alpes nuclear medicine department in 2012.

Author information

Author notes

  1. Laurent M. Riou and Gilles Barone-Rochette have contributed equally to this work.

Authors and Affiliations

  1. Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France

    Loïc Djaïleb, Nicolas De Leiris, Olivier Phan Sy, Julien Leenhardt, Marine Faure, Jessica Caillard & Daniel Fagret

  2. Cardiology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France

    Marjorie Canu, Clémence Charlon, Gérald Vanzetto & Gilles Barone-Rochette

  3. Endocrinology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France

    Anne-Laure Borel, Sandrine Lablanche & Cécile Betry

  4. Clinical Investigation Center-Technological Innovation, INSERM CIC1406, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France

    Alexandre Seiller

  5. INSERM, LRB, Univ. Grenoble Alpes, 38000, Grenoble, France

    Alexis Broisat, Catherine Ghezzi & Laurent M. Riou

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  1. Loïc Djaïleb
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Correspondence to Loïc Djaïleb.

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GBR has received research grants from Merck Sharp and Dohme and consulting fees from Bayer, Abbott vascular, Novo Nordisk, Sanofi, and AMGEN.

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This study was funded by grants from Coronary Heart Disease Research Association of Grenoble and Grenoble Alpes University Hospital.

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Djaïleb, L., De Leiris, N., Canu, M. et al. Regional CZT myocardial perfusion reserve for the detection of territories with simultaneously impaired CFR and IMR in patients without obstructive coronary artery disease: a pilot study. J. Nucl. Cardiol. 30, 1656–1667 (2023). https://doi.org/10.1007/s12350-023-03206-6

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