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Diagnostic value of quantitative myocardial blood flow assessment by NaI(Tl) SPECT in detecting significant stenosis: a prospective, multi-center study

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Objectives

The aim of this prospective multi-center study was to investigate the diagnostic value of myocardial blood flow (MBF) quantification using NaI(Tl)-based single-photon emission computed tomography (SPECT) for determining coronary artery disease (CAD) defined by quantitative coronary angiography (QCA).

Background

Absolute quantitation of MBF and myocardial flow reserve (MFR) using SPECT is clinically feasible; however, whether flow quantification using NaI(Tl) SPECT is superior to commonly performed SPECT myocardial perfusion imaging (MPI) in determining CAD has not been evaluated.

Methods

Patients with suspected or known CAD underwent pharmacological stress/rest dynamic SPECT imaging and routine SPECT MPI followed by QCA. Obstructive disease was defined as ≥ 50% reduction in luminal diameter on QCA.

Results

One hundred fifty-four patients (462 vessels) were included in the analysis. Obstructive CAD was detected in 76/154 patients (49.4%) and 112/462 vessels (24.2%). Optimal cut-off values were 1.86 mL/min/g for stress MBF and 1.95 for MFR, respectively. Stress MBF and MFR were more sensitive than MPI in both individual patients (stress MBF vs MPI: 81.6% vs 51.3%; MFR vs MPI: 72.4% vs 51.3%) and in coronary vascular regions (stress MBF vs MPI: 78.6% vs 31.3%; MFR vs MPI: 75.9% vs 31.3%; all P < .01). In receiver operating characteristic curve analysis, quantification revealed a significantly greater area under the curve than MPI at the patient (stress MBF vs MPI: 0.761 vs 0.641; MFR vs MPI: 0.770 vs 0.641) and the vessel (stress MBF vs MPI: 0.745 vs 0.613; MFR vs MPI: 0.756 vs 0.613; all P < .05) levels. Integrating quantitative SPECT measures with MPI significantly increased the area under the curve and improved the discriminatory and reclassification capacity.

Conclusion

Flow quantification using NaI(Tl) SPECT provides superior sensitivity and discriminatory capacity to MPI in detecting significant stenosis.

Clinical trial registration NCT03637725.

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Abbreviations

SPECT:

Single-photon emission computed tomography

PET:

Positron emission tomography

MPI:

Myocardial perfusion imaging

CAD:

Coronary arterial disease

CZT:

Cadmium zinc telluride

MFR:

Myocardial flow reserve

MBF:

Myocardial blood flow

QCA:

Quantitative coronary angiography

ROC:

The receiver operating characteristic

AUC:

Area under the curve

References

  1. Ben-Haim S, Murthy VL, Breault C, et al. Quantification of myocardial perfusion reserve using dynamic SPECT imaging in humans: A feasibility study. J Nucl Med 2013;54:873‐9.

    Article  CAS  PubMed  Google Scholar 

  2. Hsu B, Chen FC, Wu TC, et al. Quantitation of myocardial blood flow and myocardial flow reserve with 99mTc-sestamibi dynamic SPECT/CT to enhance detection of coronary artery disease. Eur J Nucl Med Mol Imaging 2014;41:2294‐306.

    Article  CAS  PubMed  Google Scholar 

  3. Hsu B, Hu LH, Yang BH, et al. SPECT myocardial blood flow quantitation toward clinical use: A comparative study with 13N-ammonia PET myocardial blood flow quantitation. Eur J Nucl Med Mol Imaging 2017;44:117‐28.

    Article  CAS  PubMed  Google Scholar 

  4. Agostini D, Roule V, Nganoa C, et al. First validation of myocardial flow reserve assessed by dynamic 99mTc-sestamibi CZT-SPECT camera: Head to head comparison with 15O-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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Bom MJ, Diemen PA, Driessen R, et al. Prognostic value of [15O]H2O positron emission tomography-derived global and regional myocardial perfusion. Eur Heart J Cardiovasc Imaging 2020;21:777‐86.

    Article  PubMed  Google Scholar 

  6. Feher A, Srivastava A, Quail MA, et al. Serial assessment of coronary flow reserve by rubidium-82 positron emission tomography predicts mortality in heart transplant recipients. JACC Cardiovasc Imaging 2020;13:109‐20.

    Article  PubMed  Google Scholar 

  7. Diemen PA, Wijmenga JT, Driessen R, et al. Defining the prognostic value of [15O]H2O positron emission tomography-derived myocardial ischaemic burden. Eur Heart J Cardiovasc Imaging 2021;22:638‐46.

    Article  PubMed  Google Scholar 

  8. Fiechter M, Ghadri JR, Gebhard C, et al. Diagnostic value of 13N-ammonia myocardial perfusion PET: Added value of myocardial flow reserve. J Nucl Med 2012;53:1230‐4.

    Article  CAS  PubMed  Google Scholar 

  9. Wang L, Wu D, Yang Y, et al. Avoiding full corrections in dynamic SPECT images impacts the performance of SPECT myocardial blood flow quantitation. J Nucl Cardiol 2017;24:1332‐46.

    Article  PubMed  Google Scholar 

  10. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics 1988;44:837‐45.

    Article  CAS  PubMed  Google Scholar 

  11. Nkoulou R, Fuchs TA, Pazhenkottil AP, et al. Absolute myocardial blood flow and flow reserve assessed by gated SPECT with cadmium-zinc-telluride detectors using 99mTc-Tetrofosmin: Head-to-head comparison with 13N-ammonia PET. J Nucl Med 2016;57:1887‐92.

    Article  CAS  PubMed  Google Scholar 

  12. Wells RG, Marvin B, Poirier M, et al. Optimization of SPECT measurement of myocardial blood flow with corrections for attenuation, motion, and blood binding compared with PET. J Nucl Med 2017;58:2013‐9.

    Article  CAS  PubMed  Google Scholar 

  13. Zavadovsky KV, Mochula AV, Boshchenko AA, et al. Absolute myocardial blood flows derived by dynamic CZT scan vs invasive fractional flow reserve: Correlation and accuracy. J Nucl Cardiol 2021;28:249‐59.

    Article  PubMed  Google Scholar 

  14. Ma R, Wang L, Wu D, et al. Myocardial blood flow quantitation in patients with congestive heart failure: Head-to-head comparison between rapid-rotating gantry SPECT and CZT SPECT. J Nucl Cardiol 2020;27:2287‐302.

    Article  PubMed  Google Scholar 

  15. Murthy VL, Bateman TM, Beanlands BS, et al. Clinical quantification of myocardial blood flow using PET: Joint position paper of the SNMMI Cardiovascular Council and the ASNC. J Nucl Med 2018;59:273‐93.

    Article  CAS  PubMed  Google Scholar 

  16. Ziadi MC, Dekemp RA, Williams K, et al. Does quantification of myocardial flow reserve using rubidium-82 positron emission tomography facilitate detection of multivessel coronary artery disease? J Nucl Cardiol 2012;19:670‐80.

    Article  PubMed  Google Scholar 

  17. Naya M, Murthy VL, Taqueti V, et al. Preserved coronary flow reserve effectively excludes high-risk coronary artery disease on angiography. J Nucl Med 2014;55:248‐55.

    Article  PubMed  Google Scholar 

  18. de Souza AC, Gonçalves B, Tedeschi AL, et al. 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 2021;28:876‐84.

    Article  PubMed  Google Scholar 

  19. Lee JM, Kim CH, Koo BK, et al. Integrated myocardial perfusion imaging diagnostics improve detection of functionally significant coronary artery stenosis by 13N-ammonia positron emission tomography. Circ Cardiovasc Imaging 2016;9:e004768. https://doi.org/10.1161/CIRCIMAGING.116.004768.

    Article  PubMed  Google Scholar 

  20. Danad I, Uusitalo V, Kero T, et al. Quantitative assessment of myocardial perfusion in the detection of significant coronary artery disease: Cutoff values and diagnostic accuracy of quantitative [(15)O]H2O PET imaging. J Am Coll Cardiol 2014;64:1464‐75.

    Article  PubMed  Google Scholar 

  21. Bouallègue FB, Roubille F, Lattuca B, 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.

    Article  PubMed  Google Scholar 

  22. Han S, Kim YH, Ahn JM, et al. Feasibility of dynamic stress 201Tl/rest 99mTc-tetrofosmin single photon emission computed tomography for quantification of myocardial perfusion reserve in patients with stable coronary artery disease. Eur Heart J Cardiovasc Imaging 2018;45:2173‐80.

    CAS  Google Scholar 

  23. Serruys PW, Onuma Y, Garg S, et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention 2009;5:50‐6.

    Article  PubMed  Google Scholar 

  24. Farooq V, Klaveren D, Steyerberg EW, et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: Development and validation of SYNTAX score II. Lancet 2013;381:639‐50.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China

    Lei Wang MD, Meng Wang MD, Dayong Wu MD, Yawen Wang MD & Wei Fang MD

  2. Department of Nuclear Medicine, China-Japan Friendship Hospital, National Center for Respiratory Diseases, Beijing, China

    Yumin Zheng MD

  3. Department of Nuclear Medicine, Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China

    Jie Zhang MD

  4. Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China

    Hong Qiu MD

  5. Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO, USA

    Bailing Hsu PhD

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  1. Lei Wang MD
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Correspondence to Wei Fang MD.

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The work was supported by Beijing Municipal Science and Technology Plan Project Funding (Z191100006619017).

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Wang, L., Zheng, Y., Zhang, J. et al. Diagnostic value of quantitative myocardial blood flow assessment by NaI(Tl) SPECT in detecting significant stenosis: a prospective, multi-center study. J. Nucl. Cardiol. 30, 769–780 (2023). https://doi.org/10.1007/s12350-022-03085-3

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  • DOI: https://doi.org/10.1007/s12350-022-03085-3

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