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Myocardial perfusion imaging with a cadmium zinc telluride-based gamma camera versus invasive fractional flow reserve

European Journal of Nuclear Medicine and Molecular Imaging volume 41, pages 956–962 (2014)Cite this article

Abstract

Purpose

Recently introduced ultrafast cardiac SPECT cameras with cadmium zinc telluride-based (CZT) detectors may provide superior image quality allowing faster acquisition with reduced radiation doses. Although the level of concordance between conventional SPECT and invasive fractional flow reserve (FFR) measurement has been studied, that between FFR and CZT-based SPECT is not yet known. Therefore, we aimed to assess the level of concordance between CZT SPECT and FFR in a large patient group with stable coronary artery disease.

Methods

Both invasive FFR and myocardial perfusion imaging with a CZT-based SPECT camera, using Tc-tetrofosmin as tracer, were performed in 100 patients with stable angina and intermediate grade stenosis on invasive coronary angiography. A cut-off value of <0.75 was used to define abnormal FFR.

Results

The mean age of the patients was 64 ± 11 years, and 64 % were men. SPECT demonstrated ischaemia in 31 % of the patients, and 20 % had FFR <0.75. The concordance between CZT SPECT and FFR was 73 % on a per-patient basis and 79 % on a per-vessel basis. Discordant findings were more often seen in older patients and were mainly (19 %) the result of ischaemic SPECT findings in patients with FFR ≥0.75, whereas only 8 % had an abnormal FFR without ischaemia as demonstrated by CZT SPECT.

Conclusion

Only 20 – 30 % of patients with intermediate coronary stenoses had significant ischaemia as assessed by CZT SPECT or invasive FFR. CZT SPECT showed a modest degree of concordance with FFR, which is comparable with previous results with conventional SPECT. Further investigations are particularly necessary in patients with normal SPECT and abnormal FFR, especially to determine whether these patients should undergo revascularization.

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References

  1. Shaw JL, Iskandrian AE. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol. 2004;11:171–85.

    PubMed  Article  Google Scholar 

  2. Marcassa C, Bax JJ, Bengel F, Hesse B, Petersen CL, Reyes E, et al. Clinical value, cost-effectiveness, and safety of myocardial perfusion scintigraphy: a position statement. Eur Heart J. 2008;29:557–63.

    PubMed  Article  Google Scholar 

  3. Høilund-Carlsen PF, Johansen A, Christensen HW, Vach W, Møldrup M, Bartram P, et al. Potential impact of myocardial perfusion scintigraphy as gatekeeper for invasive examination and treatment in patients with stable angina pectoris: observational study without post-test referral bias. Eur Heart J. 2006;27:29–34.

    PubMed  Article  Google Scholar 

  4. Buechel RR, Herzog BA, Husmann L, Burger IA, Pazhenkottil AP, Treyer V, et al. Ultrafast nuclear myocardial perfusion imaging on a new gamma camera with semiconductor detector technique: first clinical validation. Eur J Nucl Med Mol Imaging. 2010;37:773–8.

    PubMed  Article  Google Scholar 

  5. Herzog BA, Buechel RR, Katz R, Brueckner M, Husmann L, Burger IA, et al. Nuclear myocardial perfusion imaging with a cadmium-zinc-telluride detector technique: optimized protocol for scan time reduction. J Nucl Med. 2010;51:46–51.

    PubMed  Article  Google Scholar 

  6. Duvall WL, Croft LB, Godiwala T, Ginsberg E, George T, Henzlova MJ. Reduced isotope dose with rapid SPECT MPI imaging: initial experience with a CZT SPECT camera. J Nucl Cardiol. 2010;17:1009–14.

    PubMed  Article  Google Scholar 

  7. Nakazato R, Tamarappoo BK, Kang X, Wolak A, Kite F, Hayes SW, et al. Quantitative upright-supine high-speed SPECT myocardial perfusion imaging for detection of coronary artery disease: correlation with invasive coronary angiography. J Nucl Med. 2010;51:1724–31.

    PubMed Central  PubMed  Article  Google Scholar 

  8. Herzog BA, Buechel RR, Husmann L, Pazhenkottil AP, Burger IA, Wolfrum M, et al. Validation of CT attenuation correction for high-speed myocardial perfusion imaging using a novel cadmium-zinc-telluride detector technique. J Nucl Med. 2010;51:1539–44.

    PubMed  Article  Google Scholar 

  9. Mouden M, Timmer JR, Ottervanger JP, Reiffers S, Oostdijk AH, Knollema S, et al. Impact of a new ultrafast CZT SPECT camera for myocardial perfusion imaging: fewer equivocal results and lower radiation dose. Eur J Nucl Med Mol Imaging. 2012;39:1048–55.

    PubMed  Article  Google Scholar 

  10. Fiechter M, Ghadri JR, Kuest SM, Pazhenkottil AP, Wolfrum M, Nkoulou RN, et al. Nuclear myocardial perfusion imaging with a novel cadmium-zinc-telluride detector SPECT/CT device: first validation versus invasive coronary angiography. Eur J Nucl Med Mol Imaging. 2011;38:2025–30.

    CAS  PubMed  Article  Google Scholar 

  11. Duvall WL, Sweeny JM, Croft LB, Barghash MH, Kulkarni NK, Guma KA, et al. Comparison of high efficiency CZT SPECT MPI to coronary angiography. J Nucl Cardiol. 2011;18:595–604.

    PubMed  Article  Google Scholar 

  12. Duvall WL, Sweeny JM, Croft LB, Ginsberg E, Guma KA, Henzlova MJ. Reduced stress dose with rapid acquisition CZT SPECT MPI in a non-obese clinical population: comparison to coronary angiography. J Nucl Cardiol. 2012;19:19–27.

    PubMed  Article  Google Scholar 

  13. Pijls NH, De Bruyne B, Peels K, Van Der Voort PH, Bonnier HJ, Bartunek J, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenosis. N Engl J Med. 1996;334:1703–8.

    CAS  PubMed  Article  Google Scholar 

  14. De Bruyne B, Baudhuin T, Melin JA, Pijls NH, Sys SU, Bol A, et al. Coronary flow reserve calculated from pressure measurements in humans. Circulation. 1994;89:1013–22.

    PubMed  Article  Google Scholar 

  15. De Bruyne B, Bartunek J, Sys SU, Heyndrickx GR. Relation between myocardial fractional flow reserve calculated from coronary pressure measurements and exercise-induced myocardial ischemia. Circulation. 1995;92:39–46.

    PubMed  Article  Google Scholar 

  16. Pijls NH, Sels JW. Functional measurement of coronary stenosis. J Am Coll Cardiol. 2012;59:1045–57.

    PubMed  Article  Google Scholar 

  17. Christou MA, Siontis GC, Katritsis DG, Ioannidis JP. Meta-analysis of fractional flow reserve versus quantitative coronary angiography and noninvasive imaging for evaluation of myocardial ischemia. Am J Cardiol. 2007;99:450–6.

    PubMed  Article  Google Scholar 

  18. Berman DS, Abidov A, Kang X, Hayes SW, Friedman JD, Sciammarella MG, et al. Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation. J Nucl Cardiol. 2004;11:414–23.

    PubMed  Article  Google Scholar 

  19. Berman DS, Hachamovitch R, Kiat H, Cohen I, Cabico JA, Wang FP, et al. Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol. 1995;26:639–47.

    CAS  PubMed  Article  Google Scholar 

  20. Cerqueira MD, Weismann NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circ. 2002;105:539–42.

    Article  Google Scholar 

  21. Kajander SA, Joutsiniemi E, Saraste M, Pietilä M, Ukkonen H, Saraste A, et al. Clinical value of absolute quantification of myocardial perfusion imaging with (15)O-water in coronary artery disease. Circ Cardiovasc Imaging. 2011;4(6):678–84.

    PubMed  Article  Google Scholar 

  22. Mak GS, Kern MJ, Patel PM. Influence of obstructive sleep apnea and treatment with continuous positive airway pressure on fractional flow reserve measurements for coronary lesion assessment. Catheter Cardiovasc Interv. 2010;75:207–13.

    PubMed  Article  Google Scholar 

  23. Gimelli A, Marzullo P, L'Abbate A, Rovai D. 'False-positive' myocardial perfusion imaging: correlation with cardiovascular risk factors and effect on event-free survival. J Cardiovasc Med (Hagerstown). 2008;9:707–13.

    Article  Google Scholar 

  24. Fiechter M, Gebhard C, Fuchs TA, Ghadri JR, Stehli J, Kazakauskaite E, et al. Cadmium-zinc-telluride myocardial perfusion imaging in obese patients. J Nucl Med. 2012;53:1401–6.

    CAS  PubMed  Article  Google Scholar 

  25. Ragosta M, Bishop AH, Lipson LC, Watson DD, Gimple LW, Sarembock IJ, et al. Comparison between angiography and fractional flow reserve versus single-photon emission computed tomographic myocardial perfusion imaging for determining lesion significance in patients with multivessel coronary disease. Am J Cardiol. 2007;99:896–902.

    PubMed  Article  Google Scholar 

  26. Melikian N, De Bondt P, Tonino P, De Winter O, Wyffels E, Bartunek J, et al. Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease. JACC Cardiovasc Interv. 2010;3:307–14.

    PubMed  Article  Google Scholar 

  27. Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010;362:886–95.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  28. Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–16.

    CAS  PubMed  Article  Google Scholar 

  29. Bech GJ, De Bruyne B, Pijls NH, de Muinck ED, Hoorntje JC, Escaned J, et al. Fractional flow reserve to determine the appropriateness of angioplasty in moderate coronary stenosis: a randomized trial. Circulation. 2001;103:2928–34.

    CAS  PubMed  Article  Google Scholar 

  30. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van' t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24.

    CAS  PubMed  Article  Google Scholar 

  31. De Bruyne B, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367:991–1001.

    PubMed  Article  Google Scholar 

  32. Silber S, Albertsson P, Avilés FF, Camici PG, Colombo A, Hamm C, et al. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J. 2005;26:804–47.

    PubMed  Article  Google Scholar 

  33. Kushner FG, Hand M, Smith Jr SC, King SB 3rd, Anderson JL, Antman EM, et al. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2009;54:2205–41.

    PubMed  Article  Google Scholar 

  34. Lin GA, Dudley RA, Lucas FL, Malenka DJ, Vittinghoff E, Redberg RF. Frequency of stress testing to document ischemia prior to elective percutaneous coronary intervention. JAMA. 2008;300:1765–73.

    CAS  PubMed  Article  Google Scholar 

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Affiliations

  1. Department of Cardiology, Isala klinieken, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands

    Mohamed Mouden, Jan Paul Ottervanger & Jorik R. Timmer

  2. Department of Nuclear Medicine, Isala klinieken, Zwolle, The Netherlands

    Mohamed Mouden, Siert Knollema, Stoffer Reiffers, Ad H. J. Oostdijk & Pieter L. Jager

  3. Department of Cardiology, University Medical Centre Nijmegen, Nijmegen, The Netherlands

    Menko-Jan de Boer

Authors
  1. Mohamed Mouden
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  2. Jan Paul Ottervanger
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  3. Siert Knollema
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  4. Jorik R. Timmer
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  6. Ad H. J. Oostdijk
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Correspondence to Mohamed Mouden.

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Mouden, M., Ottervanger, J.P., Knollema, S. et al. Myocardial perfusion imaging with a cadmium zinc telluride-based gamma camera versus invasive fractional flow reserve. Eur J Nucl Med Mol Imaging 41, 956–962 (2014). https://doi.org/10.1007/s00259-013-2630-5

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  • DOI: https://doi.org/10.1007/s00259-013-2630-5

Keywords

  • Single photon emission computed tomography
  • Myocardial perfusion imaging
  • Cadmium zinc telluride
  • Stable coronary artery disease
  • Fractional flow reserve