Coronary Flow Reserve Assessment in Patients with Cad by Dynamic Single-Photon Emission Computed Tomography

Purpose: to assess the coronary flow reserve in patients with one,  two and multi-vessel coronary artery diseases by dynamic SPECT  using semiconductor (cadmium-zinctelluride)- based gamma camera.

Material and methods. This work included 42 patients with stable  coronary artery diseases. The first group consisted of 12 (28.6%)  patients with single and two-vessel coronary artery disease (STCAD)  (8 males and 4 females; mean age 61.5 ± 3.8 years) with  intermediate (50–70%) and significant (>70%) coronary artery  stenosis. Second group included 30 (71.4%) patients with multi- vessel coronary artery diseases (MVCAD) (22 males and 8 females;  mean age 60.1 ± 4.3 years) with a lesion >70% in at least 2 major epicardial vessels according to invasive coronary angiography. All patients underwent rest-stress dynamic SPECT as well as conventional myocardial perfusion imaging with 99mTc-MIBI as a radiopharmaceutical. All scintigraphic images were  acquired on the hybrid SPECT/CT unit (GE Discovery NM/CT 570C).  Patient with STCAD underwent invasive FFR detection.

Results. When comparing the results of MPI between the study  groups, there were no significant differences. ROC analysis showed  that the global MFR ≤ 1,42 allows to identify MVCAD with a  sensitivity and specificity 68% and 86,4%, for PSM, these values  are: 39.1% and 86.4% (AUC = 0.655, p < 0.05), respectively  (“gold” standard CAG). The sensitivity and specificity of the regional  MFR to identify the hemodynamic significance of coronary artery stenoses at a value of <1.33 was 100% (the “gold” standard of FFR). Most likely, high sensitivity and specificity in this case are associated with a small number of patients with true stenoses of FFR.

Conclusion. The performance of standard MPI in combination with  dynamic single-photon emission computed tomography allows to  increase the diagnostic significance of the scintigraphic approach in  the evaluation of myocardial microcirculation disorders in multivessel coronary artery disease. Dynamic SPECT is a promising  method of noninvasive assessment of hemodynamic significance of  coronary artery stenoses.

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