Incremental prognostic value of coronary flow reserve assessed with single-photon emission computed tomography

  • Stefania Daniele
  • Carmela Nappi
  • Wanda Acampa
  • Giovanni Storto
  • Teresa Pellegrino
  • Francesca Ricci
  • Evgjeni Xhoxhi
  • Francesco Porcaro
  • Mario Petretta
  • Alberto Cuocolo
Original Article



We assessed the prognostic value of coronary flow reserve (CFR) estimated by single-photon emission computed tomography (SPECT) in patients with suspected myocardial ischemia.

Methods and Results

Myocardial perfusion and CFR were assessed in 106 patients using dipyridamole/rest Tc-99m sestamibi SPECT and follow-up was obtained in 103 (97%) patients. Four early revascularized patients were excluded and 99 were assigned to normal (summed stress score <3) vs abnormal myocardial perfusion and to normal (≥2.0) vs abnormal CFR. During the follow-up (5.8 ± 2.1 years), 28 patients experienced a cardiac event (cardiac death, nonfatal myocardial infarction, and late revascularization). Abnormal perfusion (P < .01) and abnormal CFR (P < .05) were independent predictors of cardiac events at Cox proportional hazard regression analysis. Also in patients with normal perfusion, abnormal CFR was associated with a higher annual event rate compared with normal CFR (5.2% vs 0.7%; P < .05). CFR data improved the prognostic power of the model including clinical and myocardial perfusion data increasing the global chi-square from 18.6 to 22.8 (P < .05). Finally, at parametric survival analysis, in patients with normal perfusion the time to achieve ≥2% risk of events was >60 months in those with normal and <12 months in those with abnormal CFR.


Myocardial perfusion findings and CFR at SPECT imaging are both independent predictors of cardiac events. Estimated CFR provides incremental prognostic information over those obtained from clinical and myocardial perfusion data, particularly in patients with normal perfusion findings.

Key Words

Prognosis SPECT myocardial perfusion coronary flow reserve 



The authors have indicated they have no financial conflicts of interest.


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Copyright information

© American Society of Nuclear Cardiology 2011

Authors and Affiliations

  • Stefania Daniele
    • 1
  • Carmela Nappi
    • 2
  • Wanda Acampa
    • 3
  • Giovanni Storto
    • 3
  • Teresa Pellegrino
    • 3
  • Francesca Ricci
    • 2
  • Evgjeni Xhoxhi
    • 2
  • Francesco Porcaro
    • 2
  • Mario Petretta
    • 4
  • Alberto Cuocolo
    • 1
    • 2
    • 3
  1. 1.SDN FoundationInstitute of Diagnostic and Nuclear DevelopmentNaplesItaly
  2. 2.Department of Biomorphological and Functional SciencesUniversity Federico IINaplesItaly
  3. 3.Institute of Biostructures and Bioimages of the National Council of ResearchNaplesItaly
  4. 4.Department of Clinical Medicine, Cardiovascular and Immunological SciencesUniversity Federico IINaplesItaly

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