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Accuracy and Reproducibility of Myocardial Blood Flow Quantification by Single Photon Emission Computed Tomography Imaging in Patients With Known or Suspected Coronary Artery Disease
- Ana Carolina do A.H. de Souza,
- Hendrik J. Harms,
- Laurel Martell,
- Courtney Bibbo,
- Meagan Harrington,
- Kyle Sullivan,
- Jon Hainer,
- Sharmila Dorbala,
- Ron Blankstein,
- Viviany R. Taqueti,
- Marie Foley Kijewski,
- Mi-Ae Park,
- Alejandro Meretta,
- Christopher Breault,
- Nathaniel Roth,
- Alexis Poitrasson-Rivière,
- Prem Soman,
- Grant T. Gullberg and
- Marcelo F. Di Carli
Circulation: Cardiovascular Imaging Volume 15, Issue 61 June 2022

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Background:Single photon emission computed tomography (SPECT) has limited ability to identify multivessel and microvascular coronary artery disease. Gamma cameras with cadmium zinc telluride detectors allow the quantification of absolute myocardial blood flow (MBF) and myocardial flow reserve (MFR). However, evidence of its accuracy is limited, and of its reproducibility is lacking. We aimed to validate ^99mTc-sestamibi SPECT MBF and MFR using standard and spline-fitted reconstruction algorithms compared with ¹³N-ammonia positron emission tomography in a cohort of patients with known or suspected coronary artery disease and to evaluate the reproducibility of this technique.Methods:Accuracy was assessed in 34 participants who underwent dynamic ^99mTc-sestamibi SPECT and ¹³N-ammonia positron emission tomography and reproducibility in 14 participants who underwent 2 ^99mTc-sestamibi SPECT studies, all within 2 weeks. A rest/pharmacological stress single-day SPECT protocol was performed. SPECT images were reconstructed using a standard ordered subset expectation maximization (OSEM) algorithm with (N=21) and without (N=30) application of spline fitting. SPECT MBF was quantified using a net retention kinetic model‚ and MFR was derived as the stress/rest MBF ratio.Results:SPECT global MBF with splines showed good correlation with ¹³N-ammonia positron emission tomography (r=0.81, P<0.001) and MFR estimates (r=0.74, P<0.001). Correlations were substantially weaker for standard reconstruction without splines (r=0.61, P<0.001 and r=0.34, P=0.07, for MBF and MFR, respectively). Reproducibility of global MBF estimates with splines in paired SPECT scans was good (r=0.77, P<0.001), while ordered subset expectation maximization without splines led to decreased MBF (r=0.68, P<0.001) and MFR correlations (r=0.33, P=0.3). There were no significant differences in MBF or MFR between the 2 reproducibility scans independently of the reconstruction algorithm (P>0.05 for all).Conclusions:MBF and MFR quantification using ^99mTc-sestamibi cadmium zinc telluride SPECT with spatiotemporal spline fitting improved the correlation with ¹³N-ammonia positron emission tomography flow estimates and test/retest reproducibility. The use of splines may represent an important step toward the standardization of SPECT flow estimation.
Coronary Arterial Function and Disease in Women With No Obstructive Coronary Arteries
- Harmony R. Reynolds,
- C. Noel Bairey Merz,
- Colin Berry,
- Rohit Samuel,
- Jacqueline Saw,
- Nathaniel R. Smilowitz,
- Ana Carolina do A.H. de Souza,
- Robert Sykes,
- Viviany R. Taqueti and
- Janet Wei
Circulation Research Volume 130, Issue 418 February 2022

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Abstract
Ischemic heart disease (IHD) is the leading cause of mortality in women. While traditional cardiovascular risk factors play an important role in the development of IHD in women, women may experience sex-specific IHD risk factors and pathophysiology, and thus female-specific risk stratification is needed for IHD prevention, diagnosis, and treatment. Emerging data from the past 2 decades have significantly improved the understanding of IHD in women, including mechanisms of ischemia with no obstructive coronary arteries and myocardial infarction with no obstructive coronary arteries. Despite this progress, sex differences in IHD outcomes persist, particularly in young women. This review highlights the contemporary understanding of coronary arterial function and disease in women with no obstructive coronary arteries, including coronary anatomy and physiology, mechanisms of ischemia with no obstructive coronary arteries and myocardial infarction with no obstructive coronary arteries, noninvasive and invasive diagnostic strategies, and management of IHD.

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Accuracy and Reproducibility of Myocardial Blood Flow Quantification by Single Photon Emission Computed Tomography Imaging in Patients With Known or Suspected Coronary Artery Disease

Abstract

Coronary Arterial Function and Disease in Women With No Obstructive Coronary Arteries

Abstract