Quantification of Myocardial Blood Flow
Relationship between coronary flow reserve by CZT SPECT and invasive coronary fractional flow reserve and its potential clinical value
Fang Zhang, Cai Wenyi, Shi Jianzhou, Bu Ju, Chen Limei, Zhao Zhongqiang, Zhou Ningtian, Li Dianfu
Published 2023-03-25
Cite as Chin J Nucl Med Mol Imaging, 2023, 43(3): 133-138. DOI: 10.3760/cma.j.cn321828-20221101-00329
Abstract
ObjectiveTo evaluate the relationship between regional coronary flow reserve (CFR) obtained from cadmium-zinc-telluride SPECT(CZT SPECT) myocardial functional perfusion imaging (MFPI) and invasive fractional flow reserve (FFR) measured during coronary angiography (CAG) and its clinical value in guiding coronary interventions.
MethodsForty-two patients (30 males, 12 females, age (63.3±9.8) years) who completed CZT SPECT MFPI in the First Affiliated Hospital of Nanjing Medical University from June 2022 to September 2022 and underwent CAG within 3 months were included retrospectively. The concordance of CFR and FFR for diagnosing myocardial ischemia (CFR<2.0 and FFR<0.8) was calculated at the vascular level. The diagnostic efficacy of coronary stenosis≥70% for decreased myocardial blood flow (CFR<2.0) was calculated. Kappa test was used to analyze the data.
ResultsA total of 126 major coronary arteries were identified in 42 patients, of which 30(23.8%) had a CFR<2.0 by CZT SPECT and 33(26.2%) had stenosis≥70% in CAG. A total of 32 coronary vessels were performed with MFPI CFR and FFR measurements, of which 6 were both decreased and 21 were both normal, so the concordance rate was 84.4%(27/32)(Kappa=0.612, P<0.001). Among 33 coronary vessels with stenosis≥70%, 13 were with CFR≥2.0. Among 30 coronary vessels with CFR<2.0, 10 were with stenosis<70%. When using stenosis≥70% to diagnose CFR decreasing, the sensitivity was 66.7%(20/30), specificity was 86.5%(83/96), positive predictive value was 60.6%(20/33), negative predictive value was 89.2%(83/93), and accuracy was 81.7%(103/126).
ConclusionsThe concordance between CFR and FFR for the diagnosis of myocardial ischemia is good. Nearly 1/3 of the coronary arteries with decreased CFR have stenosis<70%, whereas nearly 40% of the coronary arteries with stenosis≥70% are not result in myocardial ischemia. Regional CFR determined by CZT SPECT may have potentially significant clinical value in the diagnosis of coronary artery disease and decision-making of coronary intervention.
Key words:
Coronary disease; Fractional flow reserve, myocardial; Myocardial perfusion imaging; Coronary angiography; Tomography, emission-computed, single-photon; Tellurium; Zine; Cadmium
Contributor Information
Fang Zhang
Department of Cardiology, Department of Cardiology for Women &
Children, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Cai Wenyi
Department of Cardiology, Department of Cardiology for Women &
Children, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Shi Jianzhou
Department of Cardiology, Department of Cardiology for Women &
Children, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Bu Ju
Department of Cardiology, Department of Cardiology for Women &
Children, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Chen Limei
Department of Cardiology, Department of Cardiology for Women &
Children, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Zhao Zhongqiang
Department of Cardiology, Department of Cardiology for Women &
Children, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Zhou Ningtian
Department of Cardiology, Department of Cardiology for Women &
Children, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Li Dianfu
Department of Cardiology, Department of Cardiology for Women &
Children, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
