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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

View larger version (49K): [in a new window]   Figure 1 Sensitivity and specificity of visual perfusion, reversible regional wall motion abnormality (RWMA) and post-stress RWMA for angiographic stenoses >70% by vascular territory. The overall and vascular territory-specific ability of Tc-99m sestamibi myocardial perfusion single photon emission computed tomography to detect (sensitivity) and exclude (specificity) angiographic stenoses >70% on the basis of a post-stress perfusion defect (summed stress [perfusion] score 4), reversible RWMA (summed difference [perfusion] score for wall motion >2) and post-stress RWMA (summed stress [perfusion] score for wall motion 4) is shown. Vascular territories are defined by specific myocardial segments (see Methods for details) typically supplied by the following coronary arteries: anterior = left anterior descending, septal and diagonal; inferior = right and posterior descending; and lateral = circumflex and obtuse marginal.

View larger version (39K): [in a new window]   Figure 2 Prevalence of reversible regional wall motion abnormality (RWMA) and reversible perfusion defects, with varying degrees of angiographic coronary stenosis by vascular territory. The percentage of patients with angiographic stenoses of 50% to 79% (mean and median values 70%) and 80% to 99% (mean and median values 90%) that show reversible RWMA (summed difference [perfusion] score for wall motion >2), compared with those that show reversible perfusion defects (summed difference [perfusion] score >2), are shown for specific vascular territories, defined by myocardial segments typically supplied by the following coronary arteries: anterior = left anterior descending, septal and diagonal; lateral = circumflex and obtuse marginal; and inferior = right and posterior descending.

View larger version (20K): [in a new window]   Figure 3 Correlation of reversible perfusion defects and reversible regional wall motion abnormality. Scatterplots and correlation coefficients between reversible perfusion (SDS) and reversible regional wall motion (SDSWM) defect scores are shown. (A) All patients (solid circles; n = 100). (B) Analysis excluding patients with significant, fixed perfusion defects (SRS <4; open circles; n = 45).