Role of SPECT Myocardial Perfusion Imaging, in Assessment and Early Diagnosis of Asymptomatic Coronary Artery Disease; An Analytical Study Conducted in a Tertiary Care Hospital of Islamabad, Pakistan
DOI:
https://doi.org/10.14738/jbemi.95.13031Keywords:
Myocardial Perfusion Imaging (MPI); Exercise Tolerance Test (ETT); Target Heart Rate (THR); Coronary Artery Disease (CAD); Ischemic Heart Disease (IHD); Framingham scoring.Abstract
Exercise Tolerance Test (ETT) and Myocardial Perfusion Imaging (MPI) are known non-invasive modalities to detect coronary artery disease (CAD). Aim of this study was to find out better modality for early detection of asymptomatic CAD. Material and Methods: 25 asymptomatic individuals with one or more cardiac risk factors were enrolled. Probability of CAD was calculated, using Framingham scoring; patients classified as low, intermediate and high-risk group. Each (n=25) underwent ETT and MPI. ETT response was categorized as normal, ischemic or equivocal. MPI results as normal, mild, moderate to severe degree defects. 18 patients had follow-up angiograms. Results: Risk stratification showed 14 patients were in intermediate group, 4 had high and 7 had low risk of CAD. In intermediate group, 6 patients had ischemic ETT changes, 10 had perfusion defects on scan and all 10 patients had ≥ 70% stenosis on coronary angiograms. In high-risk group; 2 subjects had positive ETTs, 3 had positive scans and all 3 showed significant vascular involvement on coronary angiogram. In low risk group 3 patients had positive ETT and MPS, 2 had mild vascular stenosis. Considering angiography as gold standard, we observed that MPI had sensitivity (86.66%) and specificity (90%), whereas ETT had 66.6% and 70% respectively. Positive and negative predictive values of MPI were 92.8% and 81.8 % respectively. Post-test probability of MPI was i.e. 0.72-0.88; compared to ETT which was 0.55-0.78. Conclusion: MPI is a better modality than ETT for early diagnosis of occult CAD, especially in intermediate and high risk group.
References
Gibbons RJ,”Guidelines for the management of patients with chronic stable angina: diagnosis and risk stratification.” Ann Intern Med, 135:530-547; 2001.
Goldberg RB, Mellies MJ, Sacks FM, et al. “Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the Cholesterol and Recurrent Events (CARE) trial: the CARE Investigators”. Circulation; 98:2513–251, 1998.
Mark DB, Shaw L, Harrell FE Jr, et al. “Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease”. N Engl J Med. 325:849-853., 1991.
Raymond J Gibbon ,“Myocardial perfusion imaging “, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA. Heart; 83:355-360, 2000.
Scanlon PJ, Faxon DP et al.,“ ACC/AHA guidelines for coronary angiography: executive summary and recommendation”, A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions, Circulation.;99:2345-57, 1999.
Diamond GA, Forrester JS.,“ Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease”, N Engl J Med,1979;300:1350-8.[Abstract].
DePuey EG, Rozanski A” Using gated technetium-99m-sestamibi SPECT to characterize fixed myocardial defects as infarct or artifact”. J Nucl Med 36:952, “Diabetes mellitus and exercise”.
Kwok Y, Kim C, Grady D, et al: Meta-analysis of exercise testing to detect coronary artery disease in women. Am J Cardiol 83:660, 1999.
Wilson PW, D’Agostino RB et al, “Prediction of coronary heart disease using risk factor categories”, Circulation,; 97:1837–1847, 1998.
Chatziioannou SN, Moore WH, Ford PV, et al,“ Prognostic value of myocardial perfusion imaging in patients with high exercise tolerance”,Circulation 99:867, 1999. 34
Shaw LJ, Hachamovitch R, Berman DS, et al,”The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: An observational assessment of the value of precatheterization ischemia”, The Economics of Noninvasive Diagnosis (END) Multicenter Study Group, J Am Coll Cardiol33:661,1999.
Shaw LJ, Heller GV, Travin MI, et al,“Cost analysis of diagnostic testing for coronary artery disease in women with stable chest pain. Economics of Noninvasive Diagnosis (END) study group”, JNuclCardiol6:559, 1999.
Shaw LJ, Hachamovitch R, Peterson ED, et al” Using an outcomes-based approach to identify candidates for risk stratification after exercise treadmill testing”, J Gen Intern Med :14:102-111, 1999.
Vaccarino V., Parson L., every N., et al, “Sex Based Difference in Early Mortality After Myocardial Infarction,” N engl J Med, 341: 217-227:1999.
Iskandrian AS, Johnson J, Le TT, et al, “Comparison of the treadmill exercise score and single-photon emission computed tomographic thallium imaging in risk assessment” J Nucl Cardiol 1:144, 1994.
Mahmood, Levy; Vasan, Wang. "The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective" Lancet. 383 (9921): 999–1008, 2013.
Hachamovitch,“ Risk Assessment of Patients With Known or Suspected CAD Using Stress Myocardial Perfusion SPECT”,Part I: The Ongoing Evolution of Clinical Evidence Rev Cardiovasc Med, 1:91-102, 2000
INTERHEART Study Investigators “Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study”. Lancet. 364:937-952,2004. [Abstract]
Sunita Dodani,“Prevalence and awareness of risk factors and behaviours of coronary heart disease in an urban population of Karachi, the largest city of Pakistan: a community survey” , Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Room 309, 3512, Fifth Avenue, Pittsburgh, PA 15213, USA
Rosephson RA, Shefrin E, Lakatta EG, Brant LJ, Fleg JL. Can serial exercise testing improve prediction of coronary events in asymptomatic individuals? Circulation 1990; 81:20-24.
Weiner DA, Becker L, Bonow R. The diagnostic and prognostic significance of an asymptomatic positive exercise test. Circulation 1987;75(Suppl II):II-20-II-21.
Fleg JL, Gerstenblith G, Zonderman AB, et al. Prevalence and prognostic significance of exercise-induced silent myocardial ischemia detected by thallium scintigraphy and electrocardiography in asymptomatic volunteers. Circulation 1990; 81:428-436.
Iskandrian AS, Kakki AH, Kane-Marsch S et al, “Prognostic implications of exercise thallium-201 scintigraphy in patients with suspected or known coronary artery disease. Am Heart J. 110: 135–143, 2001.
Hachamovitch R, “Cabico A, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction.” Circulation 1998; 97:535-43.
Fleg JL, Gerstenblith G, Zonderman AB, et al “Prevalence and prognostic significance of exercise-induced silent myocardial ischemia detected by thallium scintigraphy and electrocardiography in asymptomatic volunteers” Circulation ;81:428-436, 1990. 201 99m
Manrique A, Faraggi M, Vera P, et al“ Tl and Tc-MIBI gated SPECT in patients with large perfusion defects and left ventricular dysfunction: Comparison with equilibrium radionuclide angiography.” J Nucl Med 40:805, 1999.
Hachamovitch R, Berman DS, “Exercise myocardial perfusion SPECT in patients without known coronary artery disease”, Circulation; 93:905-14, 1996.
Lloyd CE, Kuller LH et al, “Coronary artery disease in IDDM: gender differences in risk factors but not risk”, Arterioscler Thromb Vasc Biol; 16:720–726 : 1996.
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