Fondazione Toscana G. Monasterio, Pisa, Italy.
Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
Int J Cardiol. 2019 Jan 1;274:388-393. doi: 10.1016/j.ijcard.2018.09.102. Epub 2018 Sep 28.
To evaluate gender-related differences in diagnostic accuracy of cadmium‑zinc-telluride (CZT) myocardial perfusion imaging in detecting single- and multi-vessel coronary artery disease (CAD).
We prospectively enrolled 1161 consecutive patients with known or suspected coronary artery disease (288, 25% women and 873, 75% men) who had been referred to our laboratory for stress-rest myocardial perfusion imaging (single-day stress-rest protocol, mean radiation dose: 4 mSv). All patients underwent coronary angiography within 30 days; significant CAD was defined in the presence of a coronary stenosis >70%. Summed stress scores (SSS), summed rest scores (SRS) and summed difference scores (SDS) were obtained. Image quality was graded "good" or better in >90% of patients.
On coronary angiography, left main trunk, left anterior descending artery, left circumflex artery and right coronary artery obstructive stenosis were seen in 13, 486, 393 and 499 patients, respectively. Global SSS was the best predictor of CAD in women (AUC = 0.866, 81% sensitivity and 79% specificity) and in men (AUC = 0.871, 76% sensitivity and 84% specificity). Interestingly, its accuracy was maintained also in patients with two-vessel (women: AUC = 0.842, p < 0.001; men: AUC 0.839, p < 0.001) or three-vessel disease (women: AUC = 0.800, p < 0.001; men: AUC 0.804, p < 0.001). There was no gender-related difference in terms of diagnostic accuracy.
Evaluation of multivessel disease can be obtained by CZT camera in men as well as in women, with high accuracy at a lower radiation exposure.
评估碲锌镉（CZT）心肌灌注成像在检测单支和多支冠状动脉疾病（CAD）中的诊断准确性是否存在性别差异。
我们前瞻性纳入了 1161 例已知或疑似冠状动脉疾病的连续患者（288 例，25%为女性，873 例，75%为男性），这些患者被转诊到我们的实验室进行应激-静息心肌灌注成像检查（单日应激-静息方案，平均辐射剂量：4mSv）。所有患者在 30 天内接受冠状动脉造影；存在 >70%的冠状动脉狭窄定义为显著 CAD。获得总和应激评分（SSS）、总和静息评分（SRS）和总和差评分（SDS）。>90%的患者的图像质量评为“良好”或更好。
冠状动脉造影显示，左主干、左前降支、左旋支和右冠状动脉有阻塞性狭窄分别见于 13、486、393 和 499 例患者。在女性（AUC=0.866，81%的敏感性和 79%的特异性）和男性（AUC=0.871，76%的敏感性和 84%的特异性）中，全球 SSS 是 CAD 的最佳预测因子。有趣的是，其准确性在两血管病变（女性：AUC=0.842，p<0.001；男性：AUC 0.839，p<0.001）或三血管病变（女性：AUC=0.800，p<0.001；男性：AUC 0.804，p<0.001）患者中也得以保持。在诊断准确性方面，不存在性别差异。
CZT 相机在男性和女性中都可以评估多支血管疾病，并且在更低的辐射暴露下具有更高的准确性。
