Key result
Dynamic MPI with CZT-SPECT detects microvascular dysfunction in 85% of INOCA patients.
Why the study?
To evaluate the usefulness of CZT-SPECT for diagnosing microvascular dysfunction and its endothelium-dependent versus endothelium-independent mechanisms in patients with INOCA.
Does dynamic myocardial perfusion imaging by CZT-SPECT with dipyridamole and cold pressor testing detect microvascular dysfunction in patients with INOCA?
Observational (n=93)
Does dynamic myocardial perfusion imaging by CZT-SPECT with dipyridamole and cold pressor testing detect microvascular dysfunction in patients with INOCA?
CZT-SPECT with dipyridamole and cold pressor testing is highly effective at non-invasively detecting and phenotyping microvascular dysfunction in patients with INOCA.
May support noninvasive MVD phenotyping by CZT-SPECT in INOCA; leaves open need for outcome validation before practice change.
Background: One of the causes of INOCA (Ischemia with Non- Obstructive Coronary Arteries) is microvascular dysfunction (MVD), which can be noninvasively assessed through the quantification of myocardial blood flow (MBF) and myocardial flow reserve (MFR). Dynamic myocardial perfusion imaging (MPI) by CZT-SPECT at rest, with dipyridamole stress test and cold pressor test (CPT) can establish the presence of two different pathophysiological mechanisms of MVD: endothelium-independent or endothelium-dependent, respectively. Objectives: The aim of this study was to evaluate the usefulness of CZT-SPECT for the diagnosis of MVD and the different mechanisms involved in patients with INOCA. Materials and Methods: A total of 93 consecutive INOCA patients were prospectively included and underwent dynamic MPI with CZT-SPECT at rest and with dipyridamole stress test and CPT. THe MBF was quantified using 4DM® software. A MFR response to dipyridamole <2, and changes in MBF (ΔMBF) <1.5 with CPT were considered abnormal responses. MVD was defined in the presence of one abnormal response or both. Results: CZT-SPECT detected MVD in 85% (n = 79) of the patients with INOCA. Forty-two percent had an abnormal response to both stressors while 43% presented an abnormal response of MBF only with CPT. Conclusion: The use of CZT-SPECT with both stress tests allowed the evaluation of different possible pathophysiological mechanisms of MVD present in most patients with INOCA
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Gobbo et al. (2022) conducted an observational in INOCA (Ischemia with Non-Obstructive Coronary Arteries) (n=93). Dynamic MPI with CZT-SPECT at rest, with dipyridamole stress test and CPT was evaluated on Detection of microvascular dysfunction (MVD). Dynamic MPI with CZT-SPECT detected microvascular dysfunction in 85% of patients with INOCA, identifying abnormal responses to both stressors in 42% and to CPT alone in 43%.
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