Coronary Flow Reserve
Incremental value of coronary flow reserve assessed by CZT-SPECT in the diagnosis of coronary artery disease
Weijia Chen, Kang Yao, Chenguang Li, Haojun Yu, Lifang Pang, Junbo Ge, Hongcheng Shi
Published 2019-12-25
Cite as Chin J Nucl Med Mol Imaging, 2019, 39(12): 714-719. DOI: 10.3760/cma.j.issn.2095-2848.2019.12.003
Abstract
ObjectiveTo investigate the incremental value of coronary flow reserve (CFR) assessed by cadmium zinc telluride(CZT)-SPECT as an adjunct to myocardial perfusion imaging (MPI) in the diagnosis of coronary artery disease (CAD).
MethodsData of 132 patients (89 males, 43 females; 40-81 years) with or suspected with CAD who successfully underwent rest and stress MPI and CFR from November 2017 to October 2018 in Zhongshan Hospital Affiliated to Fudan University were retrospectively analyzed. Based on coronary angiography (CAG) as the " gold standard" , the value of MPI and MPI+ CFR in the diagnosis of CAD was evaluated and compared. χ2 test or Fisher exact probability test was used for data analysis.
ResultsOf 132 patients, 61 (46.2%) were CAD with stenosis of at least 75% in one vessel (47.5%, 29/61), two vessels (34.4%, 21/61), or three vessels (18.0%, 11/61). A total of 104 (26.3%) vessels with stenosis of at least 75%, 25 (6.3%) vessels with stenosis of 65%-74%, and 30 (7.6%) vessels with stenosis of 50%-64% were found in 396 vessels. For detecting coronary stenosis of at least 75%, the sensitivity and accuracy of MPI on per-patient analysis were 86.89%(53/61) and 68.94%(91/132), which increased to 96.72%(59/61; χ2=3.921, P<0.05) and 87.88%(116/132; χ2=13.984, P<0.01) by MPI+ CFR. On per-vessel analysis, the sensitivity and accuracy of MPI were 72.12%(75/104) and 77.53%(307/396) and increased to 96.15%(100/104; χ2=22.511, P<0.01) and 85.10%(337/396; χ2=7.479, P<0.05) by MPI+ CFR. The sensitivity of MPI for predicting one, two, and three vessels disease were 72.41%(21/29), 42.86%(9/21), and 5/11 and were improved to 93.10%(27/29; χ2=4.350, P=0.037), 90.48%(19/21; χ2=10.714, P=0.001), and 11/11 (P=0.012) by MPI+ CFR. For coronary with stenosis of 65%-74%, the sensitivity of MPI was 24.00%(6/25) and was improved to 64.00%(16/25; χ2=8.117, P=0.004) by MPI+ CFR. For coronary with stenosis of 50%-64%, the sensitivity of MPI was 40.00%(12/30) and was improved to 76.67%(23/30; χ2=8.297, P=0.004) by MPI+ CFR.
ConclusionAs an adjunct to MPI, CFR can significantly improve the sensitivity and accuracy in the diagnosis of CAD, particularly for patients with mild stenosis and multivessel CAD.
Key words:
Coronary artery disease; Fractional flow reserve, myocardial; Myocardial perfusion imaging; Tomography, emission-computed, single-photon; Tellurium; Zinc; Cadmium
Contributor Information
Weijia Chen
Shanghai Institute of Medical Imaging
Department of Nuclear Medicine, Zhongshan Hospital, Fudan University
Institute of Nuclear Medicine, Fudan University, Shanghai 200032, China
Kang Yao
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Chenguang Li
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Haojun Yu
Shanghai Institute of Medical Imaging
Department of Nuclear Medicine, Zhongshan Hospital, Fudan University
Institute of Nuclear Medicine, Fudan University, Shanghai 200032, China
Lifang Pang
Shanghai Institute of Medical Imaging
Department of Nuclear Medicine, Zhongshan Hospital, Fudan University
Institute of Nuclear Medicine, Fudan University, Shanghai 200032, China
Junbo Ge
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Hongcheng Shi
Shanghai Institute of Medical Imaging
Department of Nuclear Medicine, Zhongshan Hospital, Fudan University
Institute of Nuclear Medicine, Fudan University, Shanghai 200032, China
