Reversible regional wall motion abnormalities on exercise technetium-99m–gated cardiac single photon emission computed tomography predict high-grade angiographic stenoses

• Published in: Journal of the American College of Cardiology 2002-03, Vol.39 (6), p.991-998
• Main Authors: Emmett, Louise, Iwanochko, Robert M, Freeman, Michael R, Barolet, Alan, Lee, Douglas S, Husain, Mansoor
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Biological and medical sciences; Cardiology; Cardiovascular system; Coronary Angiography; Coronary Stenosis - diagnosis; Coronary vessels; Exercise Test; Female; Heart - diagnostic imaging; Heart attacks; Humans; Investigative techniques, diagnostic techniques (general aspects); Ion Channel Gating - physiology; Male; Medical imaging; Medical sciences; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Radionuclide investigations; Radiopharmaceuticals; Sensitivity and Specificity; Severity of Illness Index; Sex Factors; Statistics as Topic; Stroke Volume - physiology; Technetium Tc 99m Sestamibi; Tomography; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left - physiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(02)01707-2

We sought to determine the level of angiographic stenosis at which reversible regional wall motion abnormalities (RWMA) are present on exercise stress technetium-99m (Tc-99m)– gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and whether assessments of stress and rest RWMA add incremental diagnostic information. Stress and rest gated SPECT MPI enables the detection of post-exercise stunning. Although some studies have correlated RWMA to the severity of MPI defects, only one previous study correlated RWMA on gated MPI to angiographic findings. However, this correlation excluded patients with rest perfusion defects and did not involve gating of rest images. One hundred patients undergoing angiography within six months of exercise stress Tc-99m (sestamibi)–gated SPECT MPI (in the absence of interim cardiac events or revascularization) were recruited. Images were acquired 15 to 30 min after stress and interpreted without knowledge of the Duke treadmill score, left ventricular ejection fraction and angiographic data. The sensitivity of reversibleRWMA for angiographic stenoses >70% was 53%, with a specificity of 100%. The presence of reversible RWMA was able to stratify patients with angiographic stenoses of 50% to 79% and 80% to 99% with a high positive predictive value. A good correlation was noted between the presence of reversible RWMA and the coronary artery jeopardy score (R = 0.49, p < 0.0001). Multivariate analysis showed that the post-stress RWMA, Duke treadmill and reversible RWMA scores were significant predictors of angiographic severity. Post-stress and reversible RWMA, as shown by exercise stress Tc-99m–gated SPECT MPI, are significant predictors of angiographic disease and add incremental value to MPI for the assessment of angiographic severity.