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Quantitative hyperemic reactivity in opposed limbs during myocardial perfusion imaging

A new marker of coronary artery disease

Jocelyn Dupuis, MD, PhD^*,*, André Arsenault, MD, Bernard Meloche, François Harel, MD, Cezar Staniloae, MD and Jean Grégoire, MD

^* Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
Department of Nuclear Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
Comprehensive Cardiovascular Center, Saint Vincent's Medical Center Manhattan, New York, New York

View larger version (43K): [in a new window]   Figure 1 Typical example of scintigraphic hyperemic reactivity experiments from a control subject (A) and a patient with coronary artery disease (CAD) (B). In the control subject, there is more intense tracer activity in the hyperemic right arm. The parametric ratios derived from the activity-time curves are higher in the control subject with a ratio of maximal upslopes between the hyperemic right arm over the control left arm of 7.7, a ratio of the peak activities of 6.0, and a ratio of integrals between t0 and tmax of 344. The same values in the CAD patient were lower at 1.3, 1.4, and 11, respectively.

View larger version (28K): [in a new window]   Figure 2 Mean values for the parametric ratios derived from the analysis of the activity-time curves of the hyperemic right arm divided by that of the contralateral left arm. CAD = coronary artery disease.

View larger version (18K): [in a new window]   Figure 3 The receiver-operating characteristic curve of the predictive value the ratio of maximal upslopes during scintigraphic hyperemic reactivity for the detection of patients with proven coronary artery disease. Using a threshold value of 3.55, this parameter has a sensitivity of 0.70 and a specificity of 0.60 for the prediction of coronary artery disease.