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Incremental value of combined perfusion and function over perfusion alone by gated SPECT myocardial perfusion imaging for detection of severe three-vessel coronary artery disease

Ronaldo S. L. Lima, MD, PhD^*, Denny D. Watson, PhD, Allen R. Goode, MS^*, Mir S. Siadaty, MD, MS, Michael Ragosta, MD, FACC^*, George A. Beller, MD, MACC^* and Habib Samady, MD, FACC^*,*

^* Cardiovascular Division, Department of Medicine, University of Virginia Health Systems, Charlottesville, Virginia, USA
Division of Biostatistics and Epidemiology, University of Virginia Medical School, Charlottesville, Virginia, USA
Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, USA
Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil and Faculdade de Medicina da Universidade Estacio de Sa, Rio de Janeiro, Brazil

View larger version (27K): [in a new window]   Figure 1 Comparison of single photon emission computed tomography perfusion versus perfusion/function patterns by number of defects in different vascular territories, in patients with severe angiographic three-vessel disease (n = 143). Multivessel disease pattern refers to 2-vessel pattern. Solid bars = perfusion alone; lined bars = perfusion + function.

View larger version (52K): [in a new window]   Figure 2 Exercise stress/rest Tc-99m gated single photon emission computed tomography images of a 59-year-old male with without prior known coronary artery disease, who presented with new onset exertional angina and dyspnea. He exercised to 7 metabolic equivalents, heart rate 105, and systolic blood pressure of 209 mm Hg. He developed chest pain and nondiagnostic electrocardiogram changes. Perfusion images revealed a partially reversible defect in a single vascular territory (inferior). Combined perfusion and functional images revealed abnormal thickening in multiple vascular territories (asterisks reflect abnormal thickening fractions in anterior and inferolateral territories) and global reduced left ventricular ejection fraction (47%). Coronary angiography performed after the stress test revealed 75% left main, 90% proximal left anterior descending coronary artery, and 100% right coronary artery stenoses.

View larger version (30K): [in a new window]   Figure 3 Multivariate logistic regression models for the prediction of three-vessel disease among all patients. *Chi-square 38.8 with 4 degrees of freedom, p < 0.0001; **chi-square 41.8 with 2 degrees of freedom, p < 0.00001.