Abstract 11060: Diagnostic Value of Left Ventricular Dyssynchrony of Post-Exercise and at Rest in the Detection of Multi-Vessel Coronary Artery Disease as Assessed by Single-Photon Emission Computed Tomography
Background: Although exercise-induced LV wall motion abnormality is a well-known marker for severe CAD, no study was performed to analyze LV dyssynchrony of post-stress and at rest, applying the phase analysis using the SyncToolTM to detect multi-vessel CAD.
Methods: 278 patients with suspected or known CAD underwent post exercise stress and resting gated SPECT. All of the patients underwent coronary angiography within 3-months of gated SPECT. LV dyssynchrony was evaluated using the SyncToolTM implemented in the Emory Cardiac Toolbox, and phase SD and histogram bandwidth were derived.
Results: In 128 patients with multi-vessel CAD, summed difference score (10.4±7.1 vs 4.8±5.3; p<0.0001), post-exercise increase in phase SD (8.6±7.6°vs 0.6±6.6°; p<0.0001) and histogram bandwidth (27.7±29.7°vs 3.3±13.2°; p<0.0001) were greater than in 150 patients with insignificant or single-vessel CAD. To detect multi-vessel CAD, summed difference score of =9 showed sensitivity of 52%, and specificity of 80%, while increase in phase SD =4.4° and bandwidth =14° after exercise had sensitivities of 74%, 68%, and specificities of 84%, 91%, respectively. The multivariate discriminant analysis revealed that the combination of post-stress increase in peak phase SD, histogram bandwidth, summed difference score and diabetes mellitus best identified multi-vessel CAD, with sensitivity of 73% and specificity of 89% (chi-square=168.2), compared with summed difference score and diabetes mellitus only (sensitivity 52%, specificity 81%, chi-square=35.1).
Conclusions: The addition of the phase analysis to evaluate exercise-induced LV dyssynchrony on conventional perfusion analysis, help better identify patients with multi-vessel CAD.
- Noninvasive cardiac imaging
- Coronary artery disease
- Intraventrocular dysshynchrony
- Radionuclide imaging
- © 2010 by American Heart Association, Inc.