Accuracy of exercise stress technetium 99m sestamibi SPECT imaging in the evaluation of the extent and location of coronary artery disease in patients with an earlier myocardial infraction

Abdou Elhendy, Fabiola B. Sozzi, Ron T. Van Domburg, Jeroen J. Bax, Marcel L. Geleijnse, Roelf Valkema, Eric P. Krenning, Jos R T C Roelandt

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Abstract

Background. This study assessed the accuracy of exercise methoxy isobutyl isonitrile (MIBI) single photon emission computed tomography (SPECT) in the evaluation of the extent of coronary artery disease (CAD) in patients with an earlier myocardial infarction. Methods and Results. We studied 135 patients (mean age, 57 ± 10 years; 115 men) at a mean of 4.1 years (median, 1 year) after myocardial infarction with symptom-limited bicycle exercise stress and rest MIBI SPECT imaging. Coronary angiography was performed within 3 months. Significant CAD was defined as a stenosis of 50% or larger in luminal diameter in 1 or more major coronary arteries. Myocardial perfusion defects (fixed, reversible, or both) were detected in 107 of the 113 patients with significant CAD and in 10 of the 22 patients without significant CAD (sensitivity, 95%; CI, 91 to 99; specificity, 55%; CI, 46 to 63, and accuracy, 88%; CI, 82 to 94). The specificity rate increased to 73% (CI, 65 to 80) by using only reversible perfusion defects as a means of predicting CAD. Reversible perfusion abnormalities were more frequent in patients with multivessel CAD than in patients with single-vessel CAD (51 of 64 [80%] vs 27 of 49 [55%], P <.01). Myocardial perfusion abnormalities in 2 vascular regions, which is suggestive of multivessel CAD, were detected in 35 of the 64 patients with and in 9 of the 71 patients without multivessel CAD (sensitivity for detecting CAD in more than one vascular region, 55%; CI, 46 to 63, specificity, 87%; CI, 81 to 93, and accuracy, 72%; CI, 64 to 80). The sensitivity rates for the diagnosis of left anterior descending coronary artery, left circumflex, and right coronary artery based on any defect were 80%, 70%, and 63%, respectively. The corresponding specificity rates were 70%, 76%, and 73%, respectively. Conclusions. Exercise MIBI SPECT imaging is an accurate method for the diagnosis and localization of CAD in patients with an earlier myocardial infarction. The technique provides a high specificity and moderate sensitivity for the diagnosis of multivessel CAD on the basis of myocardial perfusion abnormalities in more than 1 vascular region.

Original languageEnglish
Pages (from-to)432-438
Number of pages7
JournalJournal of Nuclear Cardiology
Volume7
Issue number5
Publication statusPublished - 2000

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Technetium Tc 99m Sestamibi
Single-Photon Emission-Computed Tomography
Coronary Artery Disease
Exercise
Perfusion
Blood Vessels
Coronary Vessels
Myocardial Infarction
Coronary Angiography
Pathologic Constriction

Keywords

  • Coronary artery disease
  • Exercise stress test
  • Myocardial infarction
  • Sestamibi single photon emission computed tomography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Accuracy of exercise stress technetium 99m sestamibi SPECT imaging in the evaluation of the extent and location of coronary artery disease in patients with an earlier myocardial infraction. / Elhendy, Abdou; Sozzi, Fabiola B.; Van Domburg, Ron T.; Bax, Jeroen J.; Geleijnse, Marcel L.; Valkema, Roelf; Krenning, Eric P.; Roelandt, Jos R T C.

In: Journal of Nuclear Cardiology, Vol. 7, No. 5, 2000, p. 432-438.

Research output: Contribution to journalArticle

Elhendy, Abdou ; Sozzi, Fabiola B. ; Van Domburg, Ron T. ; Bax, Jeroen J. ; Geleijnse, Marcel L. ; Valkema, Roelf ; Krenning, Eric P. ; Roelandt, Jos R T C. / Accuracy of exercise stress technetium 99m sestamibi SPECT imaging in the evaluation of the extent and location of coronary artery disease in patients with an earlier myocardial infraction. In: Journal of Nuclear Cardiology. 2000 ; Vol. 7, No. 5. pp. 432-438.
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title = "Accuracy of exercise stress technetium 99m sestamibi SPECT imaging in the evaluation of the extent and location of coronary artery disease in patients with an earlier myocardial infraction",
abstract = "Background. This study assessed the accuracy of exercise methoxy isobutyl isonitrile (MIBI) single photon emission computed tomography (SPECT) in the evaluation of the extent of coronary artery disease (CAD) in patients with an earlier myocardial infarction. Methods and Results. We studied 135 patients (mean age, 57 ± 10 years; 115 men) at a mean of 4.1 years (median, 1 year) after myocardial infarction with symptom-limited bicycle exercise stress and rest MIBI SPECT imaging. Coronary angiography was performed within 3 months. Significant CAD was defined as a stenosis of 50{\%} or larger in luminal diameter in 1 or more major coronary arteries. Myocardial perfusion defects (fixed, reversible, or both) were detected in 107 of the 113 patients with significant CAD and in 10 of the 22 patients without significant CAD (sensitivity, 95{\%}; CI, 91 to 99; specificity, 55{\%}; CI, 46 to 63, and accuracy, 88{\%}; CI, 82 to 94). The specificity rate increased to 73{\%} (CI, 65 to 80) by using only reversible perfusion defects as a means of predicting CAD. Reversible perfusion abnormalities were more frequent in patients with multivessel CAD than in patients with single-vessel CAD (51 of 64 [80{\%}] vs 27 of 49 [55{\%}], P <.01). Myocardial perfusion abnormalities in 2 vascular regions, which is suggestive of multivessel CAD, were detected in 35 of the 64 patients with and in 9 of the 71 patients without multivessel CAD (sensitivity for detecting CAD in more than one vascular region, 55{\%}; CI, 46 to 63, specificity, 87{\%}; CI, 81 to 93, and accuracy, 72{\%}; CI, 64 to 80). The sensitivity rates for the diagnosis of left anterior descending coronary artery, left circumflex, and right coronary artery based on any defect were 80{\%}, 70{\%}, and 63{\%}, respectively. The corresponding specificity rates were 70{\%}, 76{\%}, and 73{\%}, respectively. Conclusions. Exercise MIBI SPECT imaging is an accurate method for the diagnosis and localization of CAD in patients with an earlier myocardial infarction. The technique provides a high specificity and moderate sensitivity for the diagnosis of multivessel CAD on the basis of myocardial perfusion abnormalities in more than 1 vascular region.",
keywords = "Coronary artery disease, Exercise stress test, Myocardial infarction, Sestamibi single photon emission computed tomography",
author = "Abdou Elhendy and Sozzi, {Fabiola B.} and {Van Domburg}, {Ron T.} and Bax, {Jeroen J.} and Geleijnse, {Marcel L.} and Roelf Valkema and Krenning, {Eric P.} and Roelandt, {Jos R T C}",
year = "2000",
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volume = "7",
pages = "432--438",
journal = "Journal of Nuclear Cardiology",
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TY - JOUR

T1 - Accuracy of exercise stress technetium 99m sestamibi SPECT imaging in the evaluation of the extent and location of coronary artery disease in patients with an earlier myocardial infraction

AU - Elhendy, Abdou

AU - Sozzi, Fabiola B.

AU - Van Domburg, Ron T.

AU - Bax, Jeroen J.

AU - Geleijnse, Marcel L.

AU - Valkema, Roelf

AU - Krenning, Eric P.

AU - Roelandt, Jos R T C

PY - 2000

Y1 - 2000

N2 - Background. This study assessed the accuracy of exercise methoxy isobutyl isonitrile (MIBI) single photon emission computed tomography (SPECT) in the evaluation of the extent of coronary artery disease (CAD) in patients with an earlier myocardial infarction. Methods and Results. We studied 135 patients (mean age, 57 ± 10 years; 115 men) at a mean of 4.1 years (median, 1 year) after myocardial infarction with symptom-limited bicycle exercise stress and rest MIBI SPECT imaging. Coronary angiography was performed within 3 months. Significant CAD was defined as a stenosis of 50% or larger in luminal diameter in 1 or more major coronary arteries. Myocardial perfusion defects (fixed, reversible, or both) were detected in 107 of the 113 patients with significant CAD and in 10 of the 22 patients without significant CAD (sensitivity, 95%; CI, 91 to 99; specificity, 55%; CI, 46 to 63, and accuracy, 88%; CI, 82 to 94). The specificity rate increased to 73% (CI, 65 to 80) by using only reversible perfusion defects as a means of predicting CAD. Reversible perfusion abnormalities were more frequent in patients with multivessel CAD than in patients with single-vessel CAD (51 of 64 [80%] vs 27 of 49 [55%], P <.01). Myocardial perfusion abnormalities in 2 vascular regions, which is suggestive of multivessel CAD, were detected in 35 of the 64 patients with and in 9 of the 71 patients without multivessel CAD (sensitivity for detecting CAD in more than one vascular region, 55%; CI, 46 to 63, specificity, 87%; CI, 81 to 93, and accuracy, 72%; CI, 64 to 80). The sensitivity rates for the diagnosis of left anterior descending coronary artery, left circumflex, and right coronary artery based on any defect were 80%, 70%, and 63%, respectively. The corresponding specificity rates were 70%, 76%, and 73%, respectively. Conclusions. Exercise MIBI SPECT imaging is an accurate method for the diagnosis and localization of CAD in patients with an earlier myocardial infarction. The technique provides a high specificity and moderate sensitivity for the diagnosis of multivessel CAD on the basis of myocardial perfusion abnormalities in more than 1 vascular region.

AB - Background. This study assessed the accuracy of exercise methoxy isobutyl isonitrile (MIBI) single photon emission computed tomography (SPECT) in the evaluation of the extent of coronary artery disease (CAD) in patients with an earlier myocardial infarction. Methods and Results. We studied 135 patients (mean age, 57 ± 10 years; 115 men) at a mean of 4.1 years (median, 1 year) after myocardial infarction with symptom-limited bicycle exercise stress and rest MIBI SPECT imaging. Coronary angiography was performed within 3 months. Significant CAD was defined as a stenosis of 50% or larger in luminal diameter in 1 or more major coronary arteries. Myocardial perfusion defects (fixed, reversible, or both) were detected in 107 of the 113 patients with significant CAD and in 10 of the 22 patients without significant CAD (sensitivity, 95%; CI, 91 to 99; specificity, 55%; CI, 46 to 63, and accuracy, 88%; CI, 82 to 94). The specificity rate increased to 73% (CI, 65 to 80) by using only reversible perfusion defects as a means of predicting CAD. Reversible perfusion abnormalities were more frequent in patients with multivessel CAD than in patients with single-vessel CAD (51 of 64 [80%] vs 27 of 49 [55%], P <.01). Myocardial perfusion abnormalities in 2 vascular regions, which is suggestive of multivessel CAD, were detected in 35 of the 64 patients with and in 9 of the 71 patients without multivessel CAD (sensitivity for detecting CAD in more than one vascular region, 55%; CI, 46 to 63, specificity, 87%; CI, 81 to 93, and accuracy, 72%; CI, 64 to 80). The sensitivity rates for the diagnosis of left anterior descending coronary artery, left circumflex, and right coronary artery based on any defect were 80%, 70%, and 63%, respectively. The corresponding specificity rates were 70%, 76%, and 73%, respectively. Conclusions. Exercise MIBI SPECT imaging is an accurate method for the diagnosis and localization of CAD in patients with an earlier myocardial infarction. The technique provides a high specificity and moderate sensitivity for the diagnosis of multivessel CAD on the basis of myocardial perfusion abnormalities in more than 1 vascular region.

KW - Coronary artery disease

KW - Exercise stress test

KW - Myocardial infarction

KW - Sestamibi single photon emission computed tomography

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EP - 438

JO - Journal of Nuclear Cardiology

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