SPECT Myocardial Perfusion Reserve in Patients with Multivessel Coronary Disease: Correlation with Angiographic Findings and Invasive Fractional Flow Reserve Measurements

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Abstract
Quantification of myocardial perfusion reserve is an emerging topic in nuclear cardiology with an expected diagnostic and prognostic incremental value, especially for patients with severe coronary artery disease (CAD). The advent of new dedicated solid-state cameras have opened new perspectives for perfusion quantitation in SPECT. We appraised the feasibility of perfusion reserve estimations using a CZT camera in a cohort of multivessel patients and its pertinence with respect to angiographic data. Methods: Twenty-three patients with known multivessel CAD were prospectively enrolled. Dynamic SPECT acquisitions using 99mTc-tetrofosmin at rest and after vasodilator stress were performed using a dedicated CZT camera. Reconstructed frames were automatically segmented to extract the vascular input function and the myocardial uptake curve. A one-compartment kinetic modelling was employed to estimate global and regional uptake values (K1), then myocardial blood flow was derived using Renkin-Crone’s equation. Global and regional myocardial perfusion reserve (MPR) was assessed using flow difference (stress – rest) and flow ratio (stress / rest). All patients underwent a control coronary angiography within four weeks which served as reference for MPR indices assessment. Relevant angiographic findings included maximal stenosis and (for a subgroup of 26 vessels) invasive measurement of fractional flow reserve (FFR). A stenosis was considered obstructive if greater than 50% and an FFR abnormal if lower than 0.8. Results: Global MPR was well correlated with the number of obstructed vessels (pConclusion: Scintigraphic estimations of global and regional myocardial perfusion reserve in multivessel patients using a CZT camera appear to correlate well with invasive angiographic findings including maximal stenosis and FFR measurements.

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