Coronary Artery Disease Clinical Trial
Official title:
Prognostic Value of Myocardial Perfusion Heterogeneity in Normal Dual Isotope High Speed Myocardial Perfusion Imaging With a Semi Conductor Gamma Camera.
Myocardial perfusion imaging is an efficient tool to assess the risk of major cardiac events
for patients with known or suspected coronary artery disease. If the test is normal, or if
the abnormalities of perfusion represent less than 10% of the left ventricle myocardium, the
patient is considered at low risk and should be managed with optimal medical treatment only.
Recently, new gamma cameras using semi-conductor detectors have been developed. Their
diagnostic performances have been demonstrated and confronted with various anatomical and
functional reference techniques, such as coronary angiography and FFR. The prognostic value
of a normal SPECT MPI has not been specifically assessed yet.
Coronary microvascular dysfunction (CMVD) has been demonstrated to be an early marker of
coronary artery disease (CAD). Preliminary data suggest that myocardial perfusion
heterogeneity (a potential surrogate marker of endothelial dysfunction) can be assessed on
conventional MP-SPECT, but its additive and independent prognostic value over the presence
of myocardial ischemia remain unknown.
Accordingly, the purpose of this study is :
- To assess the prognostic value of a normal myocardial perfusion stress imaging using a
semiconductor gamma camera with a dual isotope high speed protocol,
- To evaluate the prognostic value of myocardial perfusion heterogeneity assessed by a
new automatized image processing method, in normal SPECT MPIs.
The main hypothesis is that the presence of myocardial perfusion heterogeneity is predictive
of cardiovascular events in patients referred to the Nuclear Cardiology Department for
routine evaluation of known or suspected CAD.
SPECT imaging protocol and analysis Stress tests and SPECTs are performed according to the
routine protocols in use in our center. Briefly, at peak stress, patients were injected with
thallium-201. Five to 10 minutes after stress, a 5-minutes supine acquisition was performed
followed by a 5-minutes prone acquisition. Subsequently, technetium-99m-sestamibi was
injected, and 2 minutes later a single 5-minutes rest acquisition was performed. During
stress acquisition, patients were imaged in supine and prone positions with their arms
positioned over their head. The rest acquisition was only acquired in supine position. The
gated SPECT studies were performed at each acquisition. Injected activity (IA) was adjusted
for patient weight. For weights of <80 kg/ 80-100 kg/>100 kg, thallium-201 IAs were
74/92/111 MBq and technetium-99m-sestamibi IAs were 300/370/450 MBq, respectively. A uniform
imaging pre-treatment for the reconstruction of raw myocardial perfusion imaging data was
applied, and images were reconstructed and reoriented to obtain transaxial sections of the
left ventricle according to the three standard cardiac planes.
In this study, we use a new mathematic technique from entropy analysis to provide precise,
objective, automated quantification of perfusion heterogeneity at stress with camera SPECT.
This method may be a non-invasive imaging to assess coronary microvascular dysfunction.
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Observational Model: Cohort, Time Perspective: Prospective
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