Our study assesses the routine reporting of exercise ischemia using very low-dose exercise-first myocardial perfusion SPECT in a large number of patients and under real-life conditions, by evaluating correlations with the subsequent routine reporting of coronary stenosis by angiography and with factors that predict ischemia.
Data from 13,126 routine exercise MPI reports, from 11,952 patients (31% women), using very low doses of sestamibi and a high-sensitivity cardiac CZT camera, were extracted to assess the reporting of significant MPI-ischemia (> 1 left ventricular segment), to determine the MPI normalcy rate in a group with < 5% pretest probability of coronary artery disease (CAD) (n = 378), and to assess the ability of MPI to predict a > 50% coronary stenosis in patients with available coronary angiography reports in the 3 months after the MPI (n = 713).
The median effective patient dose was 2.51 [IQR: 1.00–4.71] mSv. The normalcy rate was 98%, and the MPI-ischemia rate was independently predicted by a known CAD, the male gender, obesity, and a < 50% LV ejection fraction, ranging from 29.5% with all these risk factors represented to 1.5% when there were no risk factors. A > 50% coronary stenosis was significantly predicted by MPI-ischemia, less significantly for mild (odds ratio [95% confidence interval]: 1.61 [1.26–1.96]) than for moderate-to-severe MPI-ischemia (4.05 [3.53–4.57]) and was also impacted by having a known CAD (2.17 [1.83–2.51]), by a submaximal exercise test (1.48 [1.15–1.81]) and being ≥ 65 years of age (1.43 [1.11–1.76]).
Ischemia detected using a very low-dose exercise-first MPI protocol in a large-scale clinical cohort and under real-life routine conditions is a highly significant predictor for the subsequent reporting of coronary stenosis, although this prediction is enhanced by other variables. This weakly irradiating approach is amenable to being repeated at shorter time intervals, in target patient groups with a high probability of MPI-ischemia.
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The data that support the findings of this study are available on request from the corresponding author (MC).
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The authors wish to thank Petra Neufing for critical review of the manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its latest amendments or comparable ethics standards. All patients investigated in our department are informed that their medical data may be used for research purposes, and the present study was approved by the Ethics Committee of our University Hospital.
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Chawki, M.B., Goncalves, T., Boursier, C. et al. Assessment of the routine reporting of very low-dose exercise-first myocardial perfusion SPECT from a large-scale real-world cohort and correlation with the subsequent reporting of coronary stenosis at angiography. Eur J Nucl Med Mol Imaging (2021). https://doi.org/10.1007/s00259-021-05575-x
- CZT camera
- Low radiation dose
- Coronary stenosis
- Coronary artery disease