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The comparison of dynamic single photon emission computed tomography and fractional flow reserve in significant myocardial ischemia prediction

Session Poster session III

Speaker Konstantin Zavadovskiy

Event : ICNC, Nuclear Cardiology & Cardiac CT 2019

  • Topic : imaging
  • Sub-topic : Single Photon Emission Computed Tomography (SPECT)
  • Session type : Poster Session

Authors : K Zavadovskiy (Tomsk,RU), AV Mochula (Tomsk,RU), AA Boshchenko (Tomsk,RU), AV Vrublevsky (Tomsk,RU), AE Baev (Tomsk,RU), R Liga (Pisa,IT), A Gimelli (Pisa,IT)

K Zavadovskiy1 , AV Mochula1 , AA Boshchenko2 , AV Vrublevsky2 , AE Baev3 , R Liga4 , A Gimelli5 , 1Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Nuclear Medicine - Tomsk - Russian Federation , 2Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Atherosclerosis and Coronary Artery Disease - Tomsk - Russian Federation , 3Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Science, Interventional Radiology - Tomsk - Russian Federation , 4University of Pisa - Pisa - Italy , 5Fondazione Toscana/CNR Gabriele Monasterio, Nuclear Cardiology - Pisa - Italy ,

Single Photon Emission Computed Tomography (SPECT)

Purpose. To define the accuracy of myocardial dynamic CZT SPECT parameters in patients with moderate coronary artery stenosis submitted to invasive coronary angiography (ICA) and FFR.

Methods. 23 consecutive patients (61.2±6.8 years; 12 women) with suspected and known stable CAD were enrolled. Within 7 days all patients underwent non-invasive assessment of myocardial blood flow (MBF) and coronary flow reserve (CFR), obtained by a dynamic acquisition with CZT and Tc99-MIBI, and invasive assessment of coronary anatomy with the estimation of FFR values in at least one main coronary artery showing an intermediate coronary lesion (40-90% stenosis). The values of stress (adenosine pharmacological test) and rest MBF were calculated semi-automatically by a net retention model. The values of CFR were calculated as MBF ratio (MBF stress / MBF rest). Additionally, flow difference (FD) as the stress MBF minis the rest MBF was calculated. FFR was calculated invasively during the steady-state (60-90 sec) adenosine induced hyperemia as a ratio of the mean distal intracoronary pressure to the mean arterial pressure.

Results.  7(30%), 3(13%), and 2(9%) patients had >70% coronary lesions in 1, 2, or 3 vessels, respectively. Complete coronary occlusions were revealed in 2 vessels from 2 patients, while 35(38%) vessels did not show any relevant coronary luminal narrowing. FFR was assessed in 28 vessels showing intermediate coronary lesions. The average FFR value was 0.81±0.1. A moderate correlation between stenosis severity and FFR values was revealed (r=0.45; p=0.01). We found moderate correlations between stenosis severity and stress MBF (r=-0.46; p=0.01) as well as FD (r=-0.37; p=0.04). Significant correlations between FFR values and absolute myocardial perfusion parameters on CZT were revealed. Based on the ROC analysis, abnormal FFR values were best predicted by CZT-derived absolute stress MBF, MFR and FD with values of =0.54 ml/min/g, =1.48 and =0.18 ml/min/g, respectively showing the highest accuracy in predicting the presence of invasively determined myocardial inducible ischemia. Specifically, when regional MFR was below the cut-off value of =1.48, FFR was pathological in the 90% of the cases. Conversely, in the case of normal MFR values, FFR was preserved in the 78% of the cases

Conclusion. There is a good relationship between regional stress MFR and invasive FFR. In selected patients it could be of help in order to assess the hemodynamic significance of coronary artery stenosis non-invasively and to better stratify the risk of CAD.

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