Relationship between coronary flow reserve by CZT SPECT and invasive coronary fractional flow reserve and its potential clinical value
10.3760/cma.j.cn321828-20221101-00329
- VernacularTitle:CZT SPECT冠状动脉血流储备与冠状动脉血流储备分数的关系及其临床价值
- Author:
Zhang FANG
1
;
Wenyi CAI
;
Jianzhou SHI
;
Ju BU
;
Limei CHEN
;
Zhongqiang ZHAO
;
Ningtian ZHOU
;
Dianfu LI
Author Information
1. 南京医科大学第一附属医院心血管内科、妇幼心血管内科，南京 210029
- Keywords:
Coronary disease;
Fractional flow reserve, myocardial;
Myocardial perfusion imaging;
Coronary angiography;
Tomography, emission-computed, single-photon;
Te
- From:
Chinese Journal of Nuclear Medicine and Molecular Imaging
2023;43(3):133-138
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the relationship between regional coronary flow reserve (CFR) obtained from cadmium-zinc-telluride SPECT(CZT SPECT) myocardial functional perfusion imaging (MFPI) and invasive fractional flow reserve (FFR) measured during coronary angiography (CAG) and its clinical value in guiding coronary interventions.Methods:Forty-two patients (30 males, 12 females, age (63.3±9.8) years) who completed CZT SPECT MFPI in the First Affiliated Hospital of Nanjing Medical University from June 2022 to September 2022 and underwent CAG within 3 months were included retrospectively. The concordance of CFR and FFR for diagnosing myocardial ischemia (CFR<2.0 and FFR<0.8) was calculated at the vascular level. The diagnostic efficacy of coronary stenosis≥70% for decreased myocardial blood flow (CFR<2.0) was calculated. Kappa test was used to analyze the data. Results:A total of 126 major coronary arteries were identified in 42 patients, of which 30(23.8%) had a CFR<2.0 by CZT SPECT and 33(26.2%) had stenosis≥70% in CAG. A total of 32 coronary vessels were performed with MFPI CFR and FFR measurements, of which 6 were both decreased and 21 were both normal, so the concordance rate was 84.4%(27/32)( Kappa=0.612, P<0.001). Among 33 coronary vessels with stenosis≥70%, 13 were with CFR≥2.0. Among 30 coronary vessels with CFR<2.0, 10 were with stenosis<70%. When using stenosis≥70% to diagnose CFR decreasing, the sensitivity was 66.7%(20/30), specificity was 86.5%(83/96), positive predictive value was 60.6%(20/33), negative predictive value was 89.2%(83/93), and accuracy was 81.7%(103/126). Conclusions:The concordance between CFR and FFR for the diagnosis of myocardial ischemia is good. Nearly 1/3 of the coronary arteries with decreased CFR have stenosis<70%, whereas nearly 40% of the coronary arteries with stenosis≥70% are not result in myocardial ischemia. Regional CFR determined by CZT SPECT may have potentially significant clinical value in the diagnosis of coronary artery disease and decision-making of coronary intervention.
