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Vol 19 (2024): Continuous Publishing
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Published online: 2024-03-21

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Medium-term effects of CZT-SPECT – based treatment of coronary artery disease. Hitherto experience on use of perfusion assessment on semiconductor gammacamera in context of angiographic findings.

Michał Jan Piekarniak1, Michał Błaszczyk2, Daria Kaczmarek1, Karolina Wanat3, Michał Kośny1, Jarosław Kordian Drożdż1
DOI: 10.5603/fc.96628

Abstract

Introduction. CZT-SPECT (cadmium-zinc telluride single photon emission tomography) is a novel upgrade of myocardial perfusion scintigraphy. This study aimed to assess the means and effects of treatment of chronic coronary syndrome in patients who have undergone CZT-SPECT and ICA (invasive coronary angiography). Secondly, the authors investigated the phenomenon of multi-focal ischaemia and defined values of perfusion defects for the prediction of revascularization and past myocardial infarction.

Materials and methods. Of 820 consecutive patients tested with CZT-SPECT, 62 with ICA performed within 90 days were chosen. Their symptoms were assessed during hospitalization and after a year in phone call interview. The occurrence of major adverse cardiac events was evaluated. Patient characteristics, data from scintigraphy, ICA and follow-up were subjected to statistical processing.

Results. CZT-SPECT was performed before ICA in 79% of cases. Less often it evaluated residual stenosis. One complication was reported. The intensity of angina and coronary stenosis burden rose with the extent of induced ischaemia. 63% of patients were qualified for revascularization. 80% of patients experienced alleviation of symptoms on follow-up. Five had major adverse events. It was found that the best cut-off of induced ischaemia for revascularization was 14% (AUC 0,798) and 8% (AUC 0,644) of fixed perfusion defect for past myocardial infarction. Multi-focal ischaemia showed bound with false positives, higher values of perfusion defect to start invasive treatment, lower left ventricle ejection fraction and coronary artery bypass-graft history. Fixed perfusion defect predicted no symptom improvement and was associated with lower ejection fraction. In false positive cases left bundle branch block and muscle bridges were frequent.

Conclusions. CZT-SPECT is safe and contributes to lowering the number of ICAs. SPECT-based treatment effect after a year was satisfying. Multi-focal ischaemia and false positive perfusion tests likely had an impact on a higher-than- expected threshold for revascularization. Most of the false positive scintigraphies are explainable. The advantages of CZT-SPECT will ensure a rise in its role in the future.

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References

  1. Knuuti J, Wijns W, Saraste A, et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020; 41(3): 407–477.
  2. Imbert L, Poussier S, Franken PR, et al. Compared performance of high-sensitivity cameras dedicated to myocardial perfusion SPECT: a comprehensive analysis of phantom and human images. J Nucl Med. 2012; 53(12): 1897–1903.
  3. Baumgarten R, Cerci RJ, de Nadai Costa A, et al. Radiation exposure after myocardial perfusion imaging with Cadmium-Zinc-Telluride camera versus conventional camera. J Nucl Cardiol. 2021; 28(3): 992–999.
  4. Cantoni V, Green R, Acampa W, et al. Diagnostic performance of myocardial perfusion imaging with conventional and CZT single-photon emission computed tomography in detecting coronary artery disease: a meta-analysis. J Nucl Cardiol. 2021; 28(2): 698–715.
  5. Hindorf C, Oddstig J, Hedeer F, et al. Importance of correct patient positioning in myocardial perfusion SPECT when using a CZT camera. J Nucl Cardiol. 2014; 21(4): 695–702.
  6. Fiechter M, Gebhard C, Fuchs TA, et al. Cadmium-zinc-telluride myocardial perfusion imaging in obese patients. J Nucl Med. 2012; 53(9): 1401–1406.
  7. Hachamovitch R, Hayes SW, Friedman JD, et al. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003; 107(23): 2900–2907.
  8. Hachamovitch R, Rozanski A, Shaw LJ, et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. European Heart Journal. 2011; 32(8): 1012–1024.
  9. Gupta K, Bajaj NS, Hage FG, et al. Myocardial perfusion artifacts in left bundle branch block: a diagnostic challenge. J Nucl Cardiol. 2021; 28(2): 543–545.
  10. Ong P, Camici PG, Beltrame JF, et al. Coronary Vasomotion Disorders International Study Group (COVADIS). International standardization of diagnostic criteria for microvascular angina. Int J Cardiol. 2018; 250: 16–20.
  11. Nakazato R, Slomka PJ, Fish M, et al. Quantitative high-efficiency cadmium-zinc-telluride SPECT with dedicated parallel-hole collimation system in obese patients: results of a multi-center study. J Nucl Cardiol. 2015; 22(2): 266–275.
  12. Gimelli A, Liga R, Duce V, et al. Accuracy of myocardial perfusion imaging in detecting multivessel coronary artery disease: a cardiac CZT study. J Nucl Cardiol. 2017; 24(2): 687–695.
  13. Shipman JN, Agasthi P. Orbital Atherectomy. https://www.ncbi.nlm.nih.gov/books/NBK563144/ (24.07.2023).
  14. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. ESC Scientific Document Group. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019; 40(2): 87–165.