Sex-specific approach to gated SPECT volumetric analysis after stress and at rest to detect high-risk coronary artery disease

OBJECTIVES: To determine the role of quantitative analysis of poststress and resting left ventricular function using sex-specific criteria to detect high-risk coronary artery disease (CAD) as defined by the Duke CAD Prognostic Index. METHODS AND RESULTS: Stress technetium-99m-sestamibi-gated single-photon emission computed tomography and coronary angiography were performed in 407 consecutive patients (300 men, 107 women) with suspected CAD. The cut-off point for high-risk CAD was defined as a Duke CAD Prognostic Index of 42. The stress-to-rest ratios of end-diastolic volume (rEDV) and end-systolic volume (rESV) were analyzed. In 102 patients with high-risk CAD, the summed difference scores, rEDV and rESV, were greater than in 305 patients with low-risk to intermediate-risk CAD. The receiver operating characteristic curves revealed that the optimal cut-off points for rEDV and rESV to detect high-risk CAD were 1.10 and 1.11, respectively. Sex-specific rEDV was 1.08 in men, 1.11 in women, and sex-specific rESV was 1.09 in men and 1.20 in women. Multivariate discriminant analysis showed that the combination of sex-specific rEDV, sex-specific rESV, and summed difference scores greater than or equal to 8 best identified high-risk CAD, with a sensitivity of 75% and specificity of 76%. CONCLUSION: The addition of a sex-specific approach to left ventricular functional analysis using gated single-photon emission computed tomography on conventional perfusion analysis, may help better identify patients with high-risk CAD as defined by the Duke CAD Prognostic Index.