Author + information
- Received August 24, 2001
- Revision received December 18, 2001
- Accepted December 21, 2001
- Published online March 20, 2002.
- Louise Emmett, MB, ChB*,
- Robert M Iwanochko, MD*,
- Michael R Freeman, MD, FACC†,
- Alan Barolet, MD‡,
- Douglas S Lee, MD* and
- Mansoor Husain, MD*,* ()
- ↵*Reprint requests and correspondence:
Dr. Mansoor Husain, Robert J. Burns Nuclear Cardiology Laboratory, Toronto Western Hospital, EN12-221, 200 Elizabeth Street, Toronto, Ontario, Canada M5T-2S8.
Objectives 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.
Background 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.
Methods 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.
Results 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.
Conclusions 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.
☆ Dr. Lee is a Research Fellow of the Heart and Stroke Foundation of Canada, Canadian Institutes of Health Research. Dr. Husain is recipient of a Clinician Scientist Award of the Canadian Institutes of Health Research.
- Received August 24, 2001.
- Revision received December 18, 2001.
- Accepted December 21, 2001.
- American College of Cardiology Foundation