Reversible regional wall motion abnormalities on exercise technetium-99m–gated cardiac single photon emission computed tomography predict high-grade angiographic stenoses

Abstract

Post-stress and reversible RWMA, as shown by exercise stress Tc-99m-gated SPECT MPI, are significant predictors of angiographic disease and add incremental value to MPI for the assessment of angiographic severity.

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

“…Several reports have demonstrated that functional parameters have an incremental value over perfusion alone for the diagnosis of coronary artery disease and the evaluation of its extent and severity [76][77][78][79][80][81][82]. It is well known that the possibility of visualising the motion and thickening of apparently hypoperfused segments significantly improves the diagnostic accuracy of perfusion SPECT, particularly in terms of increased specificity [2].…”

“…For this particular purpose the presence of regional wall motion abnormalities showed a significantly higher sensitivity (88% vs 52%, p< 0.001, and 65% vs. 38%, p<0.03, respectively, in the left anterior descending and the left circumflex territories) than the finding of a severe perfusion defect, whereas the specificity was just slightly and not significantly diminished. Emmett et al observed that the analysis of regional wall motion improved the specificity of myocardial perfusion imaging in the diagnosis of coronary stenosis >70% of the vessel lumen [77]. The exclusive contribution of wall motion analysis was that the reversible wall motion abnormalities were able to stratify the patients according to the degree of angiographic coronary obstruction, with a high positive predictive value for the presence of a stenosis >80%.…”

“…The exclusive contribution of wall motion analysis was that the reversible wall motion abnormalities were able to stratify the patients according to the degree of angiographic coronary obstruction, with a high positive predictive value for the presence of a stenosis >80%. Of all gated SPECT variables, the stress wall motion score and the difference wall motion score were the sole scintigraphic predictors of the angiographic jeopardy score in multivariate analysis [77]. Yamagishi et al showed that worsening by >5 ejection fraction units on post-exercise gated SPECT increased the sensitivity of perfusion data for the detection of multi-vessel coronary artery disease from 26.9% to 43.3%, with a decline in specificity from 100% to 90.4% [79].…”

Utilidad de la tomografía computarizada de emisión de fotón único sincronizada con el electrocardiograma para la detección de isquemia miocárdica silente en diabéticos tipo 2

“…La tomografía computarizada por emisión de fotón único sincronizada con el electrocardiograma (gated-SPECT) es una técnica no invasiva en la que no sólo se valora la perfusión miocárdica, sino que además se obtienen datos de la función ventricular 6,7 , posee una alta capacidad diagnóstica en pacientes con manifestaciones clí-nicas [8][9][10] . El objetivo del presente trabajo fue determinar la utilidad de la tomografía computarizada de emisión de fotón único sincronizada al electrocardiograma para la detección de isquemia miocárdica silente en pacientes diabéticos tipo 2 sin clínica cardiovascular.…”

Transient ischemic dilation: An old but not obsolete marker of extensive coronary artery disease

“…Post-stress stunning with a decrease in ejection fraction and the appearance of new regional wall motion abnormality following exercise or pharmacologic stress has been shown as an important marker of severe CAD. 19,20 In recent years, myocardial blood flow and flow reserve by positron emission tomography have been used to identify the extent of CAD. Using rubidium-82 positron emission tomography, Ziadi et al demonstrated that myocardial flow reserve \ 2 provided added value to relative perfusion in predicting three vessel CAD, incremental over the summed stress score.…”