Accuracy of myocardial perfusion imaging in detecting multivessel coronary artery disease: A cardiac CZT study

Abstract

Background: Myocardial perfusion imaging (MPI) performed on traditional single-photon emission computed-tomography cameras has been shown to have a sub-optimal accuracy in detecting multivessel coronary artery disease (CAD).

Methods: Six-hundred and ninety-five patients were submitted to MPI on a novel cadmium-zinc-telluride (CZT) camera and coronary angiography. A coronary stenosis >70% was considered obstructive. In every patient, the summed stress score (SSS) was computed. Moreover, the regional stress scores were also calculated for every coronary territory.

Results: Four-hundred and forty-one patients had obstructive CAD in one (28%), two (19%), or three (17%) vessels. At per-patient analysis, the SSS showed a significant accuracy in detecting obstructive CAD (AUC 0.87, P < .001). Specifically, its accuracy was maintained also in patients with double (AUC 0.83; P < .001) or triple-vessels disease (AUC 0.79, P < .001), where CZT was able to correctly identify CAD extent in 64% of patients. On a per-vessel basis, CZT confirmed its high accuracy in detecting obstructive CAD (AUC 0.88, P < .001), independently from the involved coronary vessel.

Conclusions: MPI performed on a CZT camera is highly accurate in detecting obstructive CAD, independently from the coronary artery involved and the overall disease burden.

Keywords: Myocardial perfusion imaging; cadmium-zinc-telluride; coronary artery disease; multivessel disease; myocardial ischemia.