Prospective validation of a quantitative method for differentiating ischemic versus nonischemic cardiomyopathy by technetium‐99m sestamibi myocardial perfusion single‐photon emission computed tomography

Abstract

SummaryBackground: Myocardial perfusion single-photon emission computed tomography (SPECT) permits assessment of stress perfusion and resting left ventricular (LV) function. Quantitative analysis of perfusion patterns among patients with LV dysfunction offers an opportunity for developing criteria to differentiate ischemic from nonischemic cardiomyopathy.Hypothesis: Quantitative assessment of SPECT may allow differentiation between ischemic and nonischemic cardiomyopathy.Methods: We evaluated 144 patients with LV ejection fraction ≤ 40%, divided into 63 patients with nonischemic and 81 with ischemic cardiomyopathy. Mean relative myocardial counts were obtained for regions drawn over defect and normal zones on rest and stress polar perfusion maps.Results: Multivariate logistic regression analysis of significant univariate SPECT predictors of ischemic cardiomyopathy revealed that the stress defect severity ratio (SDSR) was the best predictor of ischemic cardiomyopathy (p < 0.0001). By receiver operator characteristic (ROC) curve analysis, an SDSR of ≤ 45% optimized prediction of ischemic cardiomy-

Taxonomy of segmental myocardial systolic dysfunction

“…130,131 The defects seen have mild stress defect severity ratios (>45%); however, similar abnormalities may be seen in multi-vessel coronary disease precluding the use of SPECT as the sole diagnostic tool in this situation.…”

Role of myocardial perfusion study in differentiating ischemic versus nonischemic cardiomyopathy using quantitative parameters

“…Yao et al . [ 22 ] studied 144 patients retrospectively and 89 patients prospectively and found significant age difference in the presenting age group with ICM group being the older one. In contrast to our study, Yao et al .…”

It’s not all in the numbers

“…While the approach is reasonable, 63 perfusion findings can significantly overlap in ischemic and non-ischemic cardiomyopathies (CM). 64,65 In addition, extrapolating perfusion image phenomena to adrenergic imaging is an unproven assumption.…”