CLINICAL STUDY: STRESS TESTING
Reversible regional wall motion abnormalities on exercise technetium-99m–gated cardiac single photon emission computed tomography predict high-grade angiographic stenoses
Louise Emmett, MB, ChB*,
Robert M. Iwanochko, MD*,
Michael R. Freeman, MD, FACC ,
Alan Barolet, MD ,
Douglas S. Lee, MD* and
Mansoor Husain, MD*,*
* Robert J. Burns Nuclear Cardiology Laboratory, Toronto Western Hospital, Toronto, Ontario, Canada
Terrence Donnelly Heart Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
Division of Cardiology, Mt. Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Manuscript received August 24, 2001;
revised manuscript received December 18, 2001,
accepted December 21, 2001.
* 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.
mansoor.husain{at}utoronto.ca
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 reversible RWMA 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.
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Abbreviations and Acronyms
| | SDS(WM) | | ECG | | electrocardiogram or electrocardiographic | | LV | | left ventricular | | LVEF | | left ventricular ejection fraction | | MPI | | myocardial perfusion imaging | | RWMA | | regional wall motion abnormality | | SDS(WM) | | summed difference (perfusion) score (for wall motion) | | SPECT | | single photon emission computed tomography | | SRS(WM) | | summed rest (perfusion) score (for wall motion) | | SSS(WM) | | summed stress (perfusion) score (for wall motion) | | Tc-99m | | technetium-99m | | TID | | transient ischemic dilation |
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