Journal
JOURNAL OF NUCLEAR CARDIOLOGY
Volume 23, Issue 5, Pages 1114-1122Publisher
SPRINGER
DOI: 10.1007/s12350-015-0101-z
Keywords
Myocardial perfusion imaging; ischemic heart disease; exercise stress test; pharmacological stress test; CZT
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Some specifics of cardiac stress protocols, i.e., stressor used or exercise level achieved, may impact myocardial perfusion imaging (MPI) accuracy. Four-hundred and seventy-five patients were submitted to MPI and coronary angiography. MPI was performed after exercise (303 patients) or dipyridamole stress (172 patients). A coronary stenosis aeyen70% was considered significant. In case of exercise test, a peak heart rate (HR) < 85% of the maximal age predicted was considered submaximal and categorized as follows: > 75% and < 85% (Group 1); < 75% (Group 2). At coronary angiography, 312/475 (66%) patients showed significant stenosis. In the overall population, MPI showed a high accuracy in unmasking significant coronary stenosis, independently of the stress protocol adopted (AUC .76 for exercise vs .78 for vasodilator; P = NS). However, in case of an exercise stress test, a significant interaction between peak %HR and MPI diagnostic power was evident. While an elevated accuracy was still maintained in Group 1 patients (AUC .79; P vs maximal exercise = NS), a significant drop was demonstrated in Group 2 patients (AUC .66; P vs maximal exercise = .012, and P vs Group 1 = .042). The accuracy of MPI is not influenced by the stress protocol adopted. Exercise MPI maintains an elevated accuracy as long as the %HR remains > 75%.
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