Abstract 14921: Quantitative Upright/Supine High-Speed Myocardial Perfusion Imaging: Correlation with Invasive Coronary Angiography
Background: A novel camera system (Spectrum-Dynamics, Israel) for high-speed single-photon emission computed tomography (HS-SPECT) myocardial perfusion imaging (MPI) shows excellent correlation with conventional SPECT. Our goal was to test the diagnostic accuracy of a new automated quantification of combined upright and supine myocardial SPECT for detection of coronary artery disease (CAD) (≥70% stenosis) in comparison to invasive coronary angiography (ICA).
Methods: We studied 142 patients undergoing upright and supine HS-SPECT, including 56 consecutive patients (63% males; mean age 64; 45% exercise stress) without known CAD who had diagnostic ICA within 6 months of HS-SPECT and 86 consecutive patients with a low likelihood (LLk) of CAD. Normal limits for upright and supine HS-SPECT were created from studies of patients with a LLk of CAD. Automated software adopted from supine/prone analysis was used to quantify the severity and extent of perfusion abnormality and was expressed as total perfusion deficit (TPD). TPD was obtained for upright (U-TPD), supine (S-TPD), and combined upright-supine acquisitions (C-TPD). Stress U-TPD ≥5%, S-TPD ≥5%, and C-TPD ≥3% myocardium were considered abnormal for per-patient analysis and U-, S-, C-TPD ≥2% in each coronary artery territory was considered abnormal for per-patient analysis.
Results: On a per-patient basis, the sensitivity was 91%, 88%, and 94% for U-TPD, S-TPD, and C-TPD and specificity was 59%, 73% and 86% for U-TPD, S-TPD and C-TPD. C-TPD had a larger area under the receiver operating characteristic curve than U-TPD or S-TPD for identification of stenosis ≥70% (0.94 vs. 0.88 and 0.89, p <0.05 and NS). On a per vessel basis, the sensitivity and specificity were 67% and 91% with U-TPD, 66% and 94% with S-TPD, and 69% and 97% with C-TPD (p = 0.02 for specificity U-TPD vs. C-TPD).
Conclusion: In this first comparison of HS-SPECT with ICA, new automated quantification of combined upright and supine HS-SPECT shows high diagnostic accuracy for detecting clinically significant CAD, with findings comparable to those reported using conventional SPECT.
- © 2010 by American Heart Association, Inc.