Skip to main content

Low-dose dynamic myocardial perfusion imaging by CZT-SPECT in the identification of obstructive coronary artery disease

European Journal of Nuclear Medicine and Molecular Imaging volume 47, pages 1705–1712 (2020)Cite this article

Abstract

Background

We measured myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) by a dynamic low-dose CZT-SPECT protocol in patients with suspected or known coronary artery disease (CAD) and investigated the capability of dynamic data in predicting obstructive CAD. A total of 173 patients with suspected or known CAD underwent dynamic CZT-SPECT after the injection of 155 MBq and 370 MBq of 99mTc-sestamibi for rest and stress imaging, respectively. Standard rest and stress imaging were performed at the end of each dynamic scan. A total perfusion defect (TPD) < 5% were considered normal. Obstructive CAD was defined as ≥ 70% stenosis at coronary angiography.

Results

Global MPR was lower (p < 0.05) in patients with abnormal compared with those with normal MPI (2.40 ± 0.7 vs. 2.70 ± 0.8). A weak, albeit significant correlation between TPD and MPR (r = − 0.179, p < 0.05) was found. In 91 patients with available angiographic data, hyperemic MBF (2.59 ± 1.2 vs. 3.24 ± 1.1 ml/min/g) and MPR (1.96 ± 0.7 vs. 2.74 ± 0.9) were lower (both p < 0.05) in patients with obstructive CAD (n = 21) compared with those without (n = 70). At univariable analysis, TPD, hyperemic MBF, and MPR were significant predictors of obstructive CAD, whereas only MPR was independent predictor at multivariable analysis (p < 0.05). At per vessels analysis, regional hyperemic MBF (2.59 ± 1.2 vs. 3.24 ± 1.1 ml/min/g) and regional MPR (1.96 ± 0.7 vs. 2.74 ± 0.9) were lower in the 31 vessels with obstructive CAD compared with 242 vessels without (both p < 0.05).

Conclusions

In patients with suspected or known CAD, MPR assessed by low-dose dynamic CZT-SPECT showed a good correlation with myocardial perfusion imaging findings and it could be useful to predict obstructive CAD.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Hendel RC, Berman DS, Di Carli MF, Heidenreich PA, Henkin RE, Pellikka PA, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/ SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging. J Am Coll Cardiol. 2009;53:2201–29.

    Article  Google Scholar 

  2. Green R, Cantoni V, Petretta M, Acampa W, Panico M, Buongiorno P, et al. Negative predictive value of stress myocardial perfusion imaging and coronary computed tomography angiography: a meta-analysis. J Nucl Cardiol. 2018;25:1588–97.

    Article  Google Scholar 

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

    Article  Google Scholar 

  4. Berman DS, Kang X, Slomka PJ, Gerlach J, de Yang L, Hayes SW, et al. Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease. J Nucl Cardiol. 2007;14:521–8.

    Article  Google Scholar 

  5. Bybee KA, Lee J, Markiewicz R, Longmore R, McGhie AI, O’Keefe JH, et al. Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging. J Nucl Cardiol. 2010;17:188–96.

    Article  Google Scholar 

  6. Zampella E, Acampa W, Assante R, Nappi C, Gaudieri V, Mainolfi CG, et al. Combined evaluation of regional coronary artery calcium and myocardial perfusion by (82)Rb PET/CT in the identification of obstructive coronary artery disease. Eur J Nucl Med Mol Imaging. 2018;45:521–9.

    CAS  Article  Google Scholar 

  7. Assante R, Acampa W, Zampella E, Arumugam P, Nappi C, Gaudieri V, et al. Prognostic value of atherosclerotic burden and coronary vascular function in patients with suspected coronary artery disease. Eur J Nucl Med Mol Imaging. 2017;44:2290–8.

    Article  Google Scholar 

  8. Esteves FP, Raggi P, Folks RD, Keidar Z, Askew JW, Rispler S, et al. Novel solid-state-detector dedicated cardiac camera for fast myocardial perfusion imaging: multicenter comparison with standard dual detector cameras. J Nucl Cardiol. 2009;16:927–34.

    Article  Google Scholar 

  9. Ben-Haim S, Murthy VL, Breault C, Allie R, Sitek A, Roth N, et al. Quantification of myocardial perfusion reserve using dynamic SPECT imaging in humans: a feasibility study. J Nucl Med. 2013;54:873–9.

    CAS  Article  Google Scholar 

  10. Agostini D, Roule V, Nganoa C, Roth N, Baavour R, Parienti JJ, et al. First validation of myocardial flow reserve assessed by dynamic (99m)Tc-sestamibi CZT-SPECT camera: head to head comparison with (15)O-water PET and fractional flow reserve in patients with suspected coronary artery disease. The WATERDAY study. Eur J Nucl Med Mol Imaging. 2018;45:1079–90.

    CAS  Article  Google Scholar 

  11. de Souza ACDAH, Gonçalves BKD, Tedeschi AL, Lima RSL. Quantification of myocardial flow reserve using a gamma camera with solid-state cadmium-zinc-telluride detectors: relation to angiographic coronary artery disease. J Nucl Cardiol. 2019. https://doi.org/10.1007/s12350-019-01775-z.

  12. Cerqueira MD, Weissman 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. Circulation. 2002;105:539–42 Review.

    Article  Google Scholar 

  13. Slomka PJ, Nishina H, Berman DS, Akincioglu C, Abidov A, Friedman JD, et al. Automated quantification of myocardial perfusion SPECT using simplified normal limits. J Nucl Cardiol. 2005;12:66–77.

    Article  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. Leppo JA, Meerdink DJ. Comparison of the myocardial uptake of a technetium-labeled isonitrile analogue and thallium. Circ Res. 1989;65:632–9.

    CAS  Article  Google Scholar 

  16. Yoshida K, Mullani N, Gould KL. Coronary flow and flow reserve by PET simplified for clinical applications using rubidium-82 or nitrogen-13-ammonia. J Nucl Med. 1996;37:1701–12.

    CAS  PubMed  Google Scholar 

  17. Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;64:1929–49.

    Article  Google Scholar 

  18. Petretta M, Acampa W, Daniele S, Petretta MP, Nappi C, Assante R, et al. Transient ischemic dilation in SPECT myocardial perfusion imaging for prediction of severe coronary artery disease in diabetic patients. J Nucl Cardiol. 2013;20:45–52.

    Article  Google Scholar 

  19. Ruopp MD, Perkins NJ, Whitcomb BW, Schisterman EF. Youden index and optimal cut-point estimated from observations affected by a lower limit of detection. Biom J. 2008;50:419–30.

    Article  Google Scholar 

  20. Murthy VL, Naya M, Foster CR, Hainer J, Gaber M, Di Carli G, et al. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation. 2011;124:2215–24

    Article  Google Scholar 

  21. Naya M, Murthy VL, Taqueti VR, Foster CR, Klein J, Garber M, et al. Preserved coronary flow reserve effectively excludes high-risk coronary artery disease on angiography. J Nucl Med. 2014;55:248–55.

    Article  Google Scholar 

  22. Ben Bouallègue F, Roubille F, Lattuca B, Cung TT, Macia JC, Gervasoni R, et al. SPECT myocardial perfusion reserve in patients with multivessel coronary disease: correlation with angiographic findings and invasive fractional flow reserve measurements. J Nucl Med. 2015;56:1712–7.

    CAS  Article  Google Scholar 

  23. Giubbini R, Bertoli M, Durmo R, Bonacina M, Peli A, Faggiano I, et al. Comparison between N(13)NH(3)-PET and (99m)Tc-Tetrofosmin-CZT SPECT in the evaluation of absolute myocardial blood flow and flow reserve. J Nucl Cardiol. 2019. https://doi.org/10.1007/s12350-019-01939-x.

  24. Perrin M, Djaballah W, Moulin F, Claudin M, Veran N, Imbert L, et al. Stress-first protocol for myocardial perfusion SPECT imaging with semiconductor cameras: high diagnostic performances with significant reduction in patient radiation doses. Eur J Nucl Med Mol Imaging. 2015;42:1004–11.

    CAS  Article  Google Scholar 

  25. Einstein AJ, Johnson LL, DeLuca AJ, Kontak AC, Groves DW, Stant J, et al. Radiation dose and prognosis of ultra-low-dose stress-first myocardial perfusion SPECT in patients with chest pain using a high-efficiency camera. J Nucl Med. 2015;56:545–51.

    Article  Google Scholar 

  26. Acampa W, Buechel RR, Gimelli A. Low dose in nuclear cardiology: state of the art in the era of new cadmium-zinc-telluride cameras. Eur Heart J Cardiovasc Imaging. 2016;17:591–5.

    Article  Google Scholar 

  27. Nkoulou R, Fuchs T, Pazhenkottil AP, Wolfrum M, Buechel R, Gaemperli O, et al. High efficiency gamma camera enables ultra-low fixed dose stress/rest myocardial perfusion imaging. Eur Heart J Cardiovasc Imaging. 2019;20:218–24.

    Article  Google Scholar 

  28. Petretta M, Storto G, Pellegrino T, Bonaduce D, Cuocolo A. Quantitative assessment of myocardial blood flow with SPECT. Prog Cardiovasc Dis. 2015;57:607–14.

    Article  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy

    Wanda Acampa, Roberta Assante, Teresa Mannarino, Emilia Zampella, Adriana D’Antonio, Pietro Buongiorno, Valeria Gaudieri, Carmela Nappi, Alessia Giordano, Ciro Gabriele Mainolfi & Alberto Cuocolo

  2. Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy

    Wanda Acampa

  3. Department of Translational Medical Sciences, University Federico II, Naples, Italy

    Mario Petretta

Authors
  1. Wanda Acampa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberta Assante
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Teresa Mannarino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emilia Zampella
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adriana D’Antonio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pietro Buongiorno
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Valeria Gaudieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carmela Nappi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alessia Giordano
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ciro Gabriele Mainolfi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mario Petretta
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Alberto Cuocolo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ciro Gabriele Mainolfi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Wanda Acampa and Roberta Assante shared first co-authorship.

This article is part of the Topical Collection on Cardiology

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Acampa, W., Assante, R., Mannarino, T. et al. Low-dose dynamic myocardial perfusion imaging by CZT-SPECT in the identification of obstructive coronary artery disease. Eur J Nucl Med Mol Imaging 47, 1705–1712 (2020). https://doi.org/10.1007/s00259-019-04644-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-019-04644-6

Keywords

  • CZT camera
  • Dynamic SPECT
  • Myocardial blood flow
  • Myocardial perfusion reserve