Key result
Exercise SPECT reveals a ~12% inferior perfusion defect despite non-obstructive CAD, suggesting RV overload steal.
Why the study?
The role of exercise-guided single-photon emission computed tomography in diagnosing coronary artery disease in patients with chronic obstructive pulmonary disease needed evaluation.
Does exercise-guided ECG-gated myocardial perfusion SPECT accurately assess myocardial perfusion abnormalities and stratify coronary artery disease risk in a patient with chronic obstructive pulmonary disease?
Case Report (n=1)
No
Does exercise-guided ECG-gated myocardial perfusion SPECT accurately assess myocardial perfusion abnormalities and stratify coronary artery disease risk in a patient with chronic obstructive pulmonary disease?
Answers are grounded in this paper and cite their sources.
In patients with COPD, exercise-guided myocardial perfusion SPECT is useful for cardiovascular risk stratification and detecting right ventricular overload, though severe exercise-induced bronchospasm can cause inferior wall hypoperfusion due to right coronary artery steal even in the absence of obstructive coronary stenosis.
Exercise-guided single-photon emission computed tomography (SPECT) of the myocardium is a promising modern technique for assessing myocardial perfusion. This method allows for the evaluation of regional and global contractility, the identification of perfusion defects, the determination of cardiomyocyte viability in the ischemic zone, and the characterization of metabolic and innervational processes in the myocardium. The objective of this article is to evaluate, based on a clinical case, the role of exercise-guided SPECT for assessing abnormalities in the diagnosis of coronary artery disease in patients with chronic obstructive pulmonary disease. The obtained data show that the use of single-photon myocardial perfusion scintigraphy with stress in patients with COPD is clinically justified: it provides reliable stratification of the risk of coronary heart disease, allows verification of right ventricular dysfunction and can serve as a guide for the choice of revascularization tactics, which is especially important in patients with significant pulmonary pathology.
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Tsikhanava et al. (2026) conducted a case report in Chronic obstructive pulmonary disease (COPD) and suspected coronary artery disease (n=1). ECG-gated exercise stress single-photon emission computed tomography (SPECT) with Tc-99m-MIBI vs. Coronary CT angiography (CCTA) and coronary artery calcium scoring was evaluated on Stress-induced myocardial perfusion defect (extent and total perfusion deficit) vs coronary artery stenosis on CT angiography. Exercise SPECT showed a 12% LV inferior perfusion defect (TPD 7%, SSS 5), whereas CT angiography revealed only non-obstructive CAD (CAC 22, CAD-RADS 1), suggesting RV overload steal during bronchospasm.
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