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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Diagnostic performance of different cardiac stress protocols for myocardial perf...
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Vol. 42. Issue 5.
Pages 281-288 (September - October 2023)
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Vol. 42. Issue 5.
Pages 281-288 (September - October 2023)
Original Article
Diagnostic performance of different cardiac stress protocols for myocardial perfusion imaging for the diagnosis of coronary artery disease using a cadmium-zinc-telluride camera with invasive coronary angiography correlation
Rendimiento diagnóstico de diferentes protocolos de estrés cardíaco usados en imagen de perfusión miocárdica para el diagnóstico de enfermedad coronaria usando una cámara de cadmio-zinc-telurio con correlación con angiografía coronaria
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Miguel Ochoa-Figueroaa,b,c,
Corresponding author
miguel.ochoa.figueroa@regionostergotland.se

Corresponding author at: Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85 Linköping, Sweden.
, Jeronimo Frias-Rosed, Elin Goodc,e,f, Veronica Sanchez-Rodrigueza,b, Anette Davidssona, Christos Pagonise
a Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
b Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
c Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
d Department of Pathology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
e Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
f Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Tables (3)
Table 1. Baseline characteristics of the study population. All data presented as mean (standard deviation) unless otherwise noted. (a) Angina pectoris in medical history. MPI, myocardial perfusion imaging; BMI, body mass index; SD, standard deviation.
Table 2. Statistical results for the whole group and for the different subgroups. BST=bicycle stress test, PST=pharmacological stress test, CST=combination stress test (BST+PST).
Table 3. Findings per vessel MPI vs. ICA. MPI=myocardial perfusion imaging, ICA=invasive coronary angiography, Sum=summatory.
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Abstract
Purpose

To evaluate the diagnostic performance of three different cardiac stress protocols for myocardial perfusion imaging (MPI) using a cadmium-zinc-telluride (CZT) camera with invasive coronary angiography (ICA) correlation for the diagnosis of coronary artery disease in a high risk population.

Methods

Retrospective study of 263 patients (96 women and 167 males, mean age 68 years) from which 119 patients performed a bicycle stress test (BST), 113 pharmacological stress test (PST) and 31 a combination of the two (CST) between September 2014 and December 2018. The patients then underwent myocardial perfusion imaging (MPI), followed by ICA and evaluated by means of quantitative angiography software, within six months after the MPI. The mean pre-test probability score for coronary disease according to the European Society of Cardiology criteria was 36% for the whole population. The MPI was performed in a dedicated CZT cardio camera (D-SPECT Spectrum Dynamics) with a two-day protocol, according to the European Association of Nuclear Medicine guidelines.

Results

No significant difference was observed between the three stress protocols in terms of diagnostic accuracy (BST 85%, PST 88%, CST 84%). The overall diagnostic accuracy of MPI to identify patients with any obstructive CAD at ICA was 86%, Sensitivity 93%, Specificity 54%, PPV 90% and NPV 63%.

Conclusion

The CZT D-SPECT camera achieves overall satisfactory results in the diagnosis of CAD, observing no significant differences in the diagnostic performance when the stress test was performed as a BST, PST or CST.

Keywords:
Bicycle exercise
Regadenoson
Myocardial scintigraphy
Cadmium-zinc-telluride
Coronary angiography
Coronary artery disease
Resumen
Objetivo

Evaluar el rendimiento diagnóstico de tres protocolos diferentes de estrés cardíaco utilizados en imagen de perfusión miocárdica (IPM), usando una cámara de cadmio-zinc-telurio (CZT) con correlación con angiografía coronaria (AC) para el diagnóstico de enfermedad arterial coronaria (EAC) en una población de alto riesgo.

Métodos

Estudio retrospectivo de 263 pacientes (96 mujeres y 167 varones, edad media 68 años) realizado, de los cuales 119 realizaron una prueba de estrés con bicicleta (PEB), 113 una prueba de estrés farmacológica (PEF) y 31 una combinación de ambas (PEC), entre septiembre de 2014 y diciembre de 2018. Posteriormente realizaron una IPM, seguida de AC dentro de los seis meses posteriores a la IPM. La probabilidad pre-prueba media para EAC según los criterios de la Sociedad Europea de Cardiología fue del 36%. La IPM se realizó en una cámara CZT cardio dedicada (D-SPECT Spectrum Dynamics) con un protocolo de dos días, de acuerdo con las guías de la Asociación Europea de Medicina Nuclear (EANM).

Resultados

No se observaron diferencias significativas entre los diferentes protocolos de estrés en términos de precisión diagnóstica (PEB 85%, PEF 88%, PEC 84%). La exactitud diagnóstica general de IPM para identificar pacientes con cualquier EAC obstructiva en AC fue del 86%, sensibilidad del 93%, especificidad del 54%, VPP del 90% y VPN del 63%.

Conclusión

La cámara CZT D-SPECT logra resultados generales satisfactorios en el diagnóstico de la EAC, sin encontrar diferencias significativas en el rendimiento diagnóstico cuando la prueba de esfuerzo se realizó como PEB, PEF o PEC.

Palabras clave:
Ejercicio en bicicleta
Regadenoson
Gammagrafía cardíaca
Cadmio-Zinc-Telurio
Angiografía coronaria
Enfermedad de la arteria coronaria

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