Incremental value of coronary flow reserve assessed by CZT-SPECT in the diagnosis of coronary ar-tery disease

中华核医学与分子影像杂志 Pub Date : 2019-12-25 DOI:10.3760/CMA.J.ISSN.2095-2848.2019.12.003

C. Weijia, Yao-wen Kang, Li Chenguang, Yu Haojun, Pan Lifang, G. Junbo, Shi Hong-cheng

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Abstract

Objective To investigate the incremental value of coronary flow reserve (CFR) assessed by cadmium zinc telluride(CZT)-SPECT as an adjunct to myocardial perfusion imaging (MPI) in the diagnosis of coronary artery disease (CAD). Methods Data of 132 patients (89 males, 43 females; 40-81 years) with or suspected with CAD who successfully underwent rest and stress MPI and CFR from November 2017 to October 2018 in Zhongshan Hospital Affiliated to Fudan University were retrospectively analyzed. Based on coronary angiography (CAG) as the " gold standard" , the value of MPI and MPI+ CFR in the diagnosis of CAD was evaluated and compared. χ2 test or Fisher exact probability test was used for data analysis. Results Of 132 patients, 61 (46.2%) were CAD with stenosis of at least 75% in one vessel (47.5%, 29/61), two vessels (34.4%, 21/61), or three vessels (18.0%, 11/61). A total of 104 (26.3%) vessels with stenosis of at least 75%, 25 (6.3%) vessels with stenosis of 65%-74%, and 30 (7.6%) vessels with stenosis of 50%-64% were found in 396 vessels. For detecting coronary stenosis of at least 75%, the sensitivity and accuracy of MPI on per-patient analysis were 86.89%(53/61) and 68.94%(91/132), which increased to 96.72%(59/61; χ2=3.921, P<0.05) and 87.88%(116/132; χ2=13.984, P<0.01) by MPI+ CFR. On per-vessel analysis, the sensitivity and accuracy of MPI were 72.12%(75/104) and 77.53%(307/396) and increased to 96.15%(100/104; χ2=22.511, P<0.01) and 85.10%(337/396; χ2=7.479, P<0.05) by MPI+ CFR. The sensitivity of MPI for predicting one, two, and three vessels disease were 72.41%(21/29), 42.86%(9/21), and 5/11 and were improved to 93.10%(27/29; χ2=4.350, P=0.037), 90.48%(19/21; χ2=10.714, P=0.001), and 11/11 (P=0.012) by MPI+ CFR. For coronary with stenosis of 65%-74%, the sensitivity of MPI was 24.00%(6/25) and was improved to 64.00%(16/25; χ2=8.117, P=0.004) by MPI+ CFR. For coronary with stenosis of 50%-64%, the sensitivity of MPI was 40.00%(12/30) and was improved to 76.67%(23/30; χ2=8.297, P=0.004) by MPI+ CFR. Conclusion As an adjunct to MPI, CFR can significantly improve the sensitivity and accuracy in the diagnosis of CAD, particularly for patients with mild stenosis and multivessel CAD. Key words: Coronary artery disease; Fractional flow reserve, myocardial; Myocardial perfusion imaging; Tomography, emission-computed, single-photon; Tellurium; Zinc; Cadmium

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ct - spect评价冠状动脉血流储备增量在冠状动脉疾病诊断中的价值

目的探讨碲化镉锌(CZT)-SPECT辅助心肌灌注显像(MPI)检测冠状动脉血流储备(CFR)的增量价值。方法132例患者资料(男89例，女43例;回顾性分析2017年11月至2018年10月在复旦大学附属中山医院成功行休息应激性MPI和CFR的40-81岁CAD或疑似CAD患者。以冠状动脉造影(CAG)为“金标准”，评价比较MPI和MPI+ CFR在CAD诊断中的价值。采用χ2检验或Fisher精确概率检验进行数据分析。结果132例患者中，61例(46.2%)为冠心病，其中1条血管(47.5%，29/61)、2条血管(34.4%，21/61)、3条血管(18.0%，11/61)狭窄程度≥75%。在396条血管中，狭窄75%以上的血管104条(26.3%)，狭窄65% ~ 74%的血管25条(6.3%)，狭窄50% ~ 64%的血管30条(7.6%)。对于75%以上的冠状动脉狭窄，MPI对每例患者分析的敏感性和准确性分别为86.89%(53/61)和68.94%(91/132)，分别增加到96.72%(59/61);χ2=3.921, P<0.05)， 87.88%(116/132;χ2=13.984, P<0.01)。在单支分析中，MPI的敏感性和准确性分别为72.12%(75/104)和77.53%(307/396)，分别增加到96.15%(100/104)和96.15%(100/104);χ2=22.511, P<0.01)、85.10%(337/396;χ2=7.479, P<0.05)。MPI预测一、二、三血管病变的敏感性分别为72.41%(21/29)、42.86%(9/21)和5/11，分别提高到93.10%(27/29);χ2=4.350, p =0.037)， 90.48%(19/21;χ2=10.714, P=0.001)， MPI+ CFR为11/11 (P=0.012)。对于狭窄度在65% ~ 74%的冠脉，MPI的敏感性为24.00%(6/25)，提高到64.00%(16/25);χ2=8.117, P=0.004)。对于狭窄50% ~ 64%的冠状动脉，MPI的敏感性为40.00%(12/30)，提高到76.67%(23/30);χ2=8.297, P=0.004)。结论CFR作为MPI的辅助手段，可显著提高诊断CAD的敏感性和准确性，尤其对轻度狭窄和多支冠心病患者。关键词:冠状动脉疾病;分流储备，心肌;心肌灌注显像;断层扫描，发射计算，单光子;碲;锌;镉

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来源期刊

中华核医学与分子影像杂志核医学，分子影像

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期刊介绍： Chinese Journal of Nuclear Medicine and Molecular Imaging (CJNMMI) was established in 1981, with the name of Chinese Journal of Nuclear Medicine, and renamed in 2012. As the specialized periodical in the domain of nuclear medicine in China, the aim of Chinese Journal of Nuclear Medicine and Molecular Imaging is to develop nuclear medicine sciences, push forward nuclear medicine education and basic construction, foster qualified personnel training and academic exchanges, and popularize related knowledge and raising public awareness. Topics of interest for Chinese Journal of Nuclear Medicine and Molecular Imaging include: -Research and commentary on nuclear medicine and molecular imaging with significant implications for disease diagnosis and treatment -Investigative studies of heart, brain imaging and tumor positioning -Perspectives and reviews on research topics that discuss the implications of findings from the basic science and clinical practice of nuclear medicine and molecular imaging - Nuclear medicine education and personnel training - Topics of interest for nuclear medicine and molecular imaging include subject coverage diseases such as cardiovascular diseases, cancer, Alzheimer’s disease, and Parkinson’s disease, and also radionuclide therapy, radiomics, molecular probes and related translational research.