Abstract
Objectives
To assess the diagnostic performances of CZT myocardial perfusion reserve (MPR) for the detection of territories with simultaneous impaired coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients without obstructive coronary artery disease.
Methods
Patients were prospectively included before being referred for coronary angiography. All patients underwent CZT MPR before invasive coronary angiography (ICA) and coronary physiology assessment. Rest and dipyridamole-induced stress myocardial blood flow (MBF) and MPR were quantified using 99mTc-SestaMIBI and a CZT camera. Fractional flow reserve (FFR), Thermodilution CFR, and IMR were assessed during ICA.
Results
Between December 2016 and July 2019, 36 patients were included. 25/36 patients presented no obstructive coronary artery disease. A complete functional assessment was performed in 32 arteries. No territory presented a significant ischemia on CZT myocardial perfusion imaging. A moderate yet significant correlation was observed between regional CZT MPR and CFR (r = 0.4, P = .03). Sensitivity, specificity, positive and negative predictive value, and accuracy of regional CZT MPR versus the composite invasive criterion (impaired CFR and IMR) were 87 [47% to 99%], 92% [73% to 99%], 78% [47% to 93%], 96% [78% to 99%], and 91% [75% to 98%], respectively. All territories with a regional CZT MPR ≤ 1.8 showed a CFR < 2. Regional CZT MPR values were significantly higher in arteries with CFR ≥ 2 and IMR < 25 (negative composite criterion, n = 14) than in those with CFR < 2 and IMR ≥ 25 (2.6 [2.1 to 3.6] versus 1.6 [1.2 to 1.8]), P < .01).
Conclusion
Regional CZT MPR presented excellent diagnostic performances for the detection of territories with simultaneously impaired CFR and IMR reflecting a very high cardiovascular risk in patients without obstructive coronary artery disease.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Abbreviations
- CMVD:
-
Coronary microvascular dysfunction
- CFR:
-
Coronary flow reserve
- MPR:
-
Myocardial perfusion reserve
- FFR:
-
Fractional flow reserve
- IMR:
-
Index of microcirculatory resistance
- ICA:
-
Invasive coronary angiography
- TAC:
-
Time activity curve
- MBF:
-
Myocardial blood flow
- QCA:
-
Quantitative coronary angiography
- ICC:
-
Intraclass correlation coefficient
References
van de Hoef TP, Bax M, Meuwissen M, et al. Impact of coronary microvascular function on long-term cardiac mortality in patients with acute ST-segment-elevation myocardial infarction. Circ Cardiovasc Interv 2013;6:207‐15. https://doi.org/10.1161/CIRCINTERVENTIONS.112.000168.
Pepine CJ, Anderson RD, Sharaf BL, et al. Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women’s Ischemia Syndrome Evaluation) study. J Am Coll Cardiol 2010;55:2825‐32. https://doi.org/10.1016/j.jacc.2010.01.054.
Ziadi MC, Dekemp RA, Williams KA, et al. Impaired myocardial flow reserve on rubidium-82 positron emission tomography imaging predicts adverse outcomes in patients assessed for myocardial ischemia. J Am Coll Cardiol 2011;58:740‐8. https://doi.org/10.1016/j.jacc.2011.01.065.
Murthy VL, Naya M, Foster CR, et al. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation 2011;124:2215‐24. https://doi.org/10.1161/CIRCULATIONAHA.111.050427.
Aarnoudse W, Fearon WF, Manoharan G, et al. Epicardial stenosis severity does not affect minimal microcirculatory resistance. Circulation 2004;110:2137‐42. https://doi.org/10.1161/01.CIR.0000143893.18451.0E.
Lee JM, Jung J-H, Hwang D, et al. Coronary Flow Reserve and Microcirculatory Resistance in Patients With Intermediate Coronary Stenosis. J Am Coll Cardiol 2016;67:1158‐69. https://doi.org/10.1016/j.jacc.2015.12.053.
Kunadian V, Chieffo A, Camici PG, et al. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. EuroIntervention J Eur Collab Work Group Interv Cardiol Eur Soc Cardiol 2021;16:1049‐69. https://doi.org/10.4244/EIJY20M07_01.
Ford TJ, Ong P, Sechtem U, et al. Assessment of vascular dysfunction in patients without obstructive coronary artery disease: Why, how, and when. JACC Cardiovasc Interv 2020;13:1847‐64. https://doi.org/10.1016/j.jcin.2020.05.052.
Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: executive summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;144:e368‐454. https://doi.org/10.1161/CIR.0000000000001030.
Ben-Haim S, Murthy VL, Breault C, et al. Quantification of myocardial perfusion reserve using dynamic SPECT Imaging in humans: A feasibility study. J Nucl Med 2013;54:873‐9. https://doi.org/10.2967/jnumed.112.109652.
Wells RG, Timmins R, Klein R, et al. Dynamic SPECT measurement of absolute myocardial blood flow in a porcine model. J Nucl Med Off Publ Soc Nucl Med 2014;55:1685‐91. https://doi.org/10.2967/jnumed.114.139782.
Ben Bouallègue F, Roubille F, Lattuca B, et al. SPECT Myocardial Perfusion Reserve in Patients with Multivessel Coronary Disease: Correlation with angiographic findings and invasive fractional flow reserve measurements. J Nucl Med Off Publ Soc Nucl Med 2015;56:1712‐7. https://doi.org/10.2967/jnumed.114.143164.
Acampa W, Zampella E, Assante R, et al. Quantification of myocardial perfusion reserve by CZT-SPECT: A head to head comparison with 82Rubidium PET imaging. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol 2020. https://doi.org/10.1007/s12350-020-02129-w.
Agostini D, Roule V, Nganoa C, et al. First validation of myocardial flow reserve assessed by dynamic 99mTc-sestamibi CZT-SPECT camera: head to head comparison with 15O-water PET and fractional flow reserve in patients with suspected coronary artery disease. The WATERDAY study. Eur J Nucl Med Mol Imaging 2018;45:1079‐90. https://doi.org/10.1007/s00259-018-3958-7.
de Souza AC, do AH, Gonçalves BKD, Tedeschi AL, Lima RSL. Quantification of myocardial flow reserve using a gamma camera with solid-state cadmium-zinc-telluride detectors: Relation to angiographic coronary artery disease. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol 2019. https://doi.org/10.1007/s12350-019-01775-z.
Miyagawa M, Nishiyama Y, Uetani T, et al. Estimation of myocardial flow reserve utilizing an ultrafast cardiac SPECT: Comparison with coronary angiography, fractional flow reserve, and the SYNTAX score. Int J Cardiol 2017;244:347‐53. https://doi.org/10.1016/j.ijcard.2017.06.012.
de Souza AC do AH, Harms HJ, Martell L, et al Accuracy and reproducibility of myocardial blood flow quantification by single photon emission computed tomography imaging in patients with known or suspected coronary artery disease. Circ Cardiovasc Imaging Doi: https://doi.org/10.1161/CIRCIMAGING.122.013987.
Wells RG, Marvin B, Poirier M, et al. Optimization of SPECT measurement of myocardial blood flow with corrections for attenuation, motion, and blood binding compared with PET. J Nucl Med Off Publ Soc Nucl Med 2017;58:2013‐9. https://doi.org/10.2967/jnumed.117.191049.
Knuuti J, Wijns W, Saraste A, et al. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020;41:407‐77. https://doi.org/10.1093/eurheartj/ehz425.
Djaileb L, Dubois B, de Leiris N, et al. Prospective diagnostic performance of semiconductor SPECT myocardial perfusion imaging: Wall thickening analysis reduces the need for an additional prone acquisition. Eur J Nucl Med Mol Imaging 2019;46:2042‐50. https://doi.org/10.1007/s00259-019-04415-3.
Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539‐42. https://doi.org/10.1161/hc0402.102975.
Maznyczka AM, Oldroyd KG, Greenwood JP, et al. Comparative significance of invasive measures of microvascular injury in acute myocardial infarction. Circ Cardiovasc Interv 2020;13:008505. https://doi.org/10.1161/CIRCINTERVENTIONS.119.008505.
Yong AS, Layland J, Fearon WF, et al. Calculation of the index of microcirculatory resistance without coronary wedge pressure measurement in the presence of epicardial stenosis. JACC Cardiovasc Interv 2013;6:53‐8. https://doi.org/10.1016/j.jcin.2012.08.019.
Fearon WF, Omar FHM, Balsam LB, et al. Comparison of coronary thermodilution and doppler velocity for assessing coronary flow reserve. Circulation 2003;108:2198‐200. https://doi.org/10.1161/01.CIR.0000099521.31396.9D.
Barbato E, Aarnoudse W, Aengevaeren WR, et al. Validation of coronary flow reserve measurements by thermodilution in clinical practice. Eur Heart J 2004;25:219‐23. https://doi.org/10.1016/j.ehj.2003.11.009.
Everaars H, de Waard GA, Driessen RS, et al. Doppler Flow velocity and thermodilution to assess coronary flow reserve: A head-to-head comparison with [15O]H2O PET. JACC Cardiovasc Interv 2018;11:2044‐54. https://doi.org/10.1016/j.jcin.2018.07.011.
Chih S, Chong AY, Erthal F, et al. PET assessment of epicardial intimal disease and microvascular dysfunction in cardiac allograft vasculopathy. J Am Coll Cardiol 2018;71:1444‐56. https://doi.org/10.1016/j.jacc.2018.01.062.
Lee BC, Moody JB, Weinberg RL, et al. Optimization of temporal sampling for 82rubidium PET myocardial blood flow quantification. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol 2017;24:1517‐29. https://doi.org/10.1007/s12350-017-0899-7.
Acknowledgments
Authors are grateful to Mr Capecci Philippe and Mrs Guellec Isabelle who contributed to initiate myocardial perfusion reserve quantification in CHU Grenoble Alpes nuclear medicine department in 2012.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
GBR has received research grants from Merck Sharp and Dohme and consulting fees from Bayer, Abbott vascular, Novo Nordisk, Sanofi, and AMGEN.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.
The authors have also provided an audio summary of the article, which is available to download as ESM, or to listen to via the JNC/ASNC Podcast.
This study was funded by grants from Coronary Heart Disease Research Association of Grenoble and Grenoble Alpes University Hospital.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Djaïleb, L., De Leiris, N., Canu, M. et al. Regional CZT myocardial perfusion reserve for the detection of territories with simultaneously impaired CFR and IMR in patients without obstructive coronary artery disease: a pilot study. J. Nucl. Cardiol. 30, 1656–1667 (2023). https://doi.org/10.1007/s12350-023-03206-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12350-023-03206-6