Driessen Roel S, Raijmakers Pieter G, Danad Ibrahim, Stuijfzand Wynand J, Schumacher Stefan P, Lammertsma Adriaan A, van Rossum Albert C, van Royen Niels, Underwood S Richard, Knaapen Paul
Departments of Cardiology.
Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Nucl Med Commun. 2019 Jul;40(7):773-774. doi: 10.1097/MNM.0000000000001033.
Next to myocardial perfusion, single-photon emission computed tomography (SPECT) also allows for the assessment of nonperfusion parameters such as transient ischemic dilatation (TID) and a reduction of ejection fraction (EF) with stress imaging. This study aimed to evaluate the diagnostic value of TID and EF reserve for the detection of significant multivessel coronary artery disease (CAD). A total of 206 patients with suspected stable CAD prospectively underwent gated stress-rest Tc-tetrofosmin SPECT and invasive coronary angiography with routine fractional flow reserve (FFR) measurements, irrespective of imaging results. Left ventricular volumes, TID, and EF reserve were assessed and compared with FFR-defined severity of CAD. According to FFR, 92 (45%) patients had significant CAD, whereas 25 (12%) showed 2-vessel disease (VD) and 22 (11%) showed 3-VD. With an increasing extent of CAD, TID values and EF reserve did not change significantly (P=0.07 and 0.42 for trend, respectively). Conversely, absolute left ventricular volumes and EF differed significantly among groups of CAD severity (P<0.01 for all trends). SPECT-derived TID and EF reserve did not differ between patients with high-risk CAD (3-VD) and low risk or no significant CAD. Therefore, the present results advocate exerting caution when using these ancillary findings in clinical practice.
除心肌灌注外，单光子发射计算机断层扫描（SPECT）还可用于评估非灌注参数，如短暂性缺血性扩张（TID）以及负荷成像时射血分数（EF）的降低。本研究旨在评估TID和EF储备对检测显著多支冠状动脉疾病（CAD）的诊断价值。共有206例疑似稳定型CAD患者前瞻性地接受了门控负荷-静息锝-替曲膦SPECT检查以及有创冠状动脉造影，并常规测量血流储备分数（FFR），无论成像结果如何。评估左心室容积、TID和EF储备，并与FFR定义的CAD严重程度进行比较。根据FFR，92例（45%）患者患有显著CAD，而25例（12%）显示双支血管病变（VD），22例（11%）显示三支血管病变。随着CAD范围的增加，TID值和EF储备没有显著变化（趋势P分别为0.07和0.42）。相反，CAD严重程度组之间的绝对左心室容积和EF有显著差异（所有趋势P<0.01）。高危CAD（三支血管病变）患者与低风险或无显著CAD患者之间，SPECT衍生的TID和EF储备没有差异。因此，本研究结果提倡在临床实践中使用这些辅助发现时要谨慎。
