Impact of Cardiac Size on Diagnostic Performance of Single-photon Emission Computed Tomography Myocardial Perfusion Imaging: Insights from the REgistry of Fast Myocardial Perfusion Imaging with NExt Generation Single-photon Emission Computed...

Overview

Journal Eur Heart J Cardiovasc Imaging

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
Radiology

Date 2024 Mar 6

PMID 38445511

Authors

Michael J Randazzo

Pierre Elias

Timothy J Poterucha

Tali Sharir

Matthews B Fish

Terrence D Ruddy

Philipp A Kaufmann

Albert J Sinusas

Edward J Miller

Timothy Bateman

Sharmila Dorbala

Marcelo Di Carli

Michelle Castillo

Joanna X Liang

Robert J H Miller

Damini Dey

Daniel S Berman

Piotr J Slomka

Andrew J Einstein

Affiliations

Soon will be listed here.

Abstract

Aims: Variation in diagnostic performance of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has been observed, yet the impact of cardiac size has not been well characterized. We assessed whether low left ventricular volume influences SPECT MPI's ability to detect obstructive coronary artery disease (CAD) and its interaction with age and sex.

Methods And Results: A total of 2066 patients without known CAD (67% male, 64.7 ± 11.2 years) across nine institutions underwent SPECT MPI with solid-state scanners followed by coronary angiography as part of the REgistry of Fast Myocardial Perfusion Imaging with NExt Generation SPECT. Area under receiver-operating characteristic curve (AUC) analyses evaluated the performance of quantitative and visual assessments according to cardiac size [end-diastolic volume (EDV); <20th vs. ≥20th population or sex-specific percentiles], age (<75 vs. ≥75 years), and sex. Significantly decreased performance was observed in patients with low EDV compared with those without (AUC: population 0.72 vs. 0.78, P = 0.03; sex-specific 0.72 vs. 0.79, P = 0.01) and elderly patients compared with younger patients (AUC 0.72 vs. 0.78, P = 0.03), whereas males and females demonstrated similar AUC (0.77 vs. 0.76, P = 0.67). The reduction in accuracy attributed to lower volumes was primarily observed in males (sex-specific threshold: EDV 0.69 vs. 0.79, P = 0.01). Accordingly, a significant decrease in AUC, sensitivity, specificity, and negative predictive value for quantitative and visual assessments was noted in patients with at least two characteristics of low EDV, elderly age, or male sex.

Conclusion: Detection of CAD with SPECT MPI is negatively impacted by small cardiac size, most notably in elderly and male patients.

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