Abstract
Purpose. This study assesses results from large-scale and real-life routine interpretations by multiple observers of very low-dose exercise-first myocardial perfusion SPECT imaging (MPI) and the correlation of MPI ischemia with subsequent routine reports of coronary stenosis by angiography. Methods. Data from 13,126 routine exercise-MPI reports, from 11,952 patients (31% women), using very low doses of Sestamibi and a high-sensitivity cardiac CZT-camera, were extracted to assess the reporting of significant MPI-ischemia (> 1 left ventricular segment), to determine the normalcy rate for MPI in a group with < 5% pretest likelihood of coronary artery disease (CAD) (n=378), and to assess the ability of MPI to predict a > 50% coronary stenosis in patients with available coronary angiography reports within the next three months of MPI (n=713). Results. The median of patients’ effective dose was 2.51 [IQR: 1.00-4.71] mSv. The normalcy rate was 97%, and the MPI-ischemia rate was independently related to a previous CAD history, the male gender, obesity, and a < 50% resting LV ejection fraction, ranging from 31% with all these risk factors represented, to 2% when there were no risk factors. A > 50% coronary stenosis was significantly predicted by MPI-ischemia, less significantly for mild (odd-ratio [95% confidence interval]: 1.61 [1.11-2.32]) than for moderate-to-severe MPI-ischemia (3.91 [2.24-6.84]), and was also impacted by a history of CAD (2.31 [1.56-3.44]), a sub-maximal exercise test (1.61 [1.11-2.34]) and age ≥ 65 years (1.41 [1.00-1.97]). Conclusion. Ischemia is an efficient predictor of significant CAD in routine reports of a large-scale clinical cohort and using a very low-dose exercise-first MPI protocol, although this prediction is enhanced by other variables. This weakly irradiating investigation could likely be repeated at shorter time intervals, especially in targeted patient groups with high risk of ischemia.
Ischemia Is an Efficient Predictor of Significant Coronary Artery Disease in Routine Reports of a Large-scale Clinical Cohort Using Very Low-dose Exercise-first Myocardial Perfusion SPECT
