First validation of myocardial flow reserve assessed by dynamic 99mTc-sestamibi CZT-SPECT camera: head to head comparison with 15O-water PET and fractional flow reserve in patients with suspected coronary artery disease. The WATERDAY study

Denis Agostini, Vincent Roule, Catherine Nganoa, Nathaniel Roth, Raphael Baavour, Jean-Jacques Parienti, Farzin Beygui, Alain Manrique, Denis Agostini, Vincent Roule, Catherine Nganoa, Nathaniel Roth, Raphael Baavour, Jean-Jacques Parienti, Farzin Beygui, Alain Manrique

Abstract

Purpose: We assessed the feasibility of myocardial blood flow (MBF) and flow reserve (MFR) estimation using dynamic SPECT with a novel CZT camera in patients with stable CAD, in comparison with 15O-water PET and fractional flow reserve (FFR).

Methods: Thirty patients were prospectively included and underwent FFR measurements in the main coronary arteries (LAD, LCx, RCA). A stenosis ≥50% was considered obstructive and a FFR abnormal if ≤0.8. All patients underwent a dynamic rest/stress 99mTc-sestamibi CZT-SPECT and 15O-water PET for MBF and MFR calculation. Net retention kinetic modeling was applied to SPECT data to estimate global uptake values, and MBF was derived using Leppo correction. Ischemia by PET and CZT-SPECT was considered present if MFR was lower than 2 and 2.1, respectively.

Results: CZT-SPECT yielded higher stress and rest MBF compared to PET for global and LAD and LCx territories, but not in RCA territory. MFR was similar in global and each vessel territory for both modalities. The sensitivity, specificity, accuracy, positive and negative predictive value of CZT-SPECT were, respectively, 83.3, 95.8, 93.3, 100 and 85.7% for the detection of ischemia and 58.3, 84.6, 81.1, 36.8 and 93% for the detection of hemodynamically significant stenosis (FFR ≤ 0.8).

Conclusions: Dynamic 99mTc-sestamibi CZT-SPECT was technically feasible and provided similar MFR compared to 15O-water PET and high diagnostic value for detecting impaired MFR and abnormal FFR in patients with stable CAD.

Keywords: 15O–water PET; CZT camera; Coronary artery disease; Dynamic SPECT; Fractional flow reserve; Myocardial blood flow; Myocardial flow reserve.

Conflict of interest statement

Conflict of interest

All this work was undertaken at CHU Cote de Nacre, Caen, France, which received funding from Spectrum Dynamics Ltd.

Pr Denis Agostini is a consultant for Spectrum Dynamics Ltd.

Nathaniel Roth and Rafael Baavour are employed by Spectrum Dynamics Ltd.

No other potential conflict of interest relevant to this article was reported.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Flow chart of the WATERDAY study
Fig. 2
Fig. 2
Dynamic CZT-SPECT imaging protocol
Fig. 3
Fig. 3
a. Correlation between global MBF (ml/min/g) by PET and by CZT-SPECT in 30 patients (rest: full circle; stress: empty circles). MBF estimates plotted against MBF measured by PET. The dashed line is the fit obtained from total least square regression. b. Bland-Altman plot showing the agreement between the two modalities in 30 patients for MBF (ml/min/g). c. ROC curve showing the sensitivity and specificity of CZT-SPECT for the diagnostic of abnormal stress PET MBF (< 2.5 ml/min/g)
Fig. 4
Fig. 4
a. Correlation between PET and CZT-SPECT for global MFR in 30 patients. MFR estimates by CZT-SPECT plotted against MFR measured by PET. The dashed line is the fit obtained from total least square regression. b. Bland-Altman plots between PET and CZT-SPECT for global MFR in 30 patients. c. ROC curve showing the sensitivity and specificity of CZT-SPECT for the diagnostic of abnormal stress PET MFR (< 2)
Fig. 5
Fig. 5
a. Patient W001 with normal FFR in the three coronary vessels: PET and CZT-SPECT both show normal MFR. MBF by PET and MBF by CZT-SPECT are also normal. Two stress and rest TACs are represented on the right panel during dynamic CZT-SPECT. Dynamic images show the bolus frame in the LA and LV followed by the LV myocardial activity frame. ROIs are placed on the LA for input function and on the global LV myocardium. b. Patient W008 with normal FFR in the three coronary vessels: PET and CZT-SPECT both show abnormal MFR (<2). Stress MBF by PET and MBF by CZT-SPECT are abnormal in LCx and RCA territories. Two stress and rest TACs are represented on the right panel during dynamic CZT-SPECT. Dynamic images show the bolus frame in the LA and LV followed by the LV myocardial activity frame. ROIs are placed on the LA for the input function and on global LV myocardium

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