Key result
Reversible wall motion abnormalities on exercise SPECT MPI detect severe coronary stenosis with ~100% specificity.
Why the study?
The level of angiographic stenosis at which reversible RWMA are present on exercise stress Tc-99m-gated SPECT MPI and the incremental diagnostic value of stress and rest RWMA assessments were unclear.
Do reversible regional wall motion abnormalities on exercise Tc-99m-gated SPECT MPI predict high-grade angiographic stenoses in patients undergoing angiography?
Observational (n=100)
Do reversible regional wall motion abnormalities on exercise Tc-99m-gated SPECT MPI predict high-grade angiographic stenoses in patients undergoing angiography?
Effect estimate: Sensitivity 53%, Specificity 100%; R=0.49
p-value: p=<0.0001
Post-stress and reversible regional wall motion abnormalities on Tc-99m-gated SPECT MPI provide significant predictive value for identifying severe angiographic coronary stenoses.
OBJECTIVES: We sought to determine the level of angiographic stenosis at which reversible regional wall motion abnormalities (RWMA) are present on exercise stress technetium-99m (Tc-99m)- gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and whether assessments of stress and rest RWMA add incremental diagnostic information. BACKGROUND: Stress and rest gated SPECT MPI enables the detection of post-exercise stunning. Although some studies have correlated RWMA to the severity of MPI defects, only one previous study correlated RWMA on gated MPI to angiographic findings. However, this correlation excluded patients with rest perfusion defects and did not involve gating of rest images. METHODS: One hundred patients undergoing angiography within six months of exercise stress Tc-99m (sestamibi)-gated SPECT MPI (in the absence of interim cardiac events or revascularization) were recruited. Images were acquired 15 to 30 min after stress and interpreted without knowledge of the Duke treadmill score, left ventricular ejection fraction and angiographic data. RESULTS: The sensitivity of reversible RWMA for angiographic stenoses >70% was 53%, with a specificity of 100%. The presence of reversible RWMA was able to stratify patients with angiographic stenoses of 50% to 79% and 80% to 99% with a high positive predictive value. A good correlation was noted between the presence of reversible RWMA and the coronary artery jeopardy score (R = 0.49, p < 0.0001). Multivariate analysis showed that the post-stress RWMA, Duke treadmill and reversible RWMA scores were significant predictors of angiographic severity. CONCLUSIONS: Post-stress and reversible RWMA, as shown by exercise stress Tc-99m-gated SPECT MPI, are significant predictors of angiographic disease and add incremental value to MPI for the assessment of angiographic severity.
No takes yet. Share an insight, caveat, or question.
Emmett et al. (2002) conducted an observational in Angiographic stenoses / Coronary artery disease (n=100). Reversible regional wall motion abnormalities on exercise stress Tc-99m-gated SPECT MPI vs. Absence of reversible regional wall motion abnormalities was evaluated on Presence of angiographic stenoses >70% and correlation with coronary artery jeopardy score (Sensitivity 53%, Specificity 100%; R=0.49, p=<0.0001). Reversible regional wall motion abnormalities on exercise Tc-99m-gated SPECT MPI identified angiographic stenoses >70% with 53% sensitivity and 100% specificity (correlation R=0.49, P<0.0001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: