Myocardial Perfusion SPECT Imaging in Patients after Percutaneous Coronary Intervention

Abstract

Coronary artery disease (CAD) is the most prevalent form of cardiovascular disease affecting about 13 million Americans, while more than one million percutaneous transluminal intervention (PCI) procedures are performed annually in the USA. The relative high occurrence of restenosis, despite stent implementation, seems to be the primary limitation of PCI. Over the last decades, single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), has proven an invaluable tool for the diagnosis of CAD and patients’ risk stratification, providing useful information regarding the decision about revascularization and is well suited to assess patients after intervention. Information gained from post-intervention MPI is crucial to differentiate patients with angina from those with exo-cardiac chest pain syndromes, to assess peri-intervention myocardial damage, to predict-detect restenosis after PCI, to detect CAD progression in non-revascularized vessels, to evaluate the effects of intervention if required for occupational reasons and to evaluate patients’ long-term prognosis. On the other hand, chest pain and exercise electrocardiography are largely unhelpful in identifying patients at risk after PCI.Although there are enough published data demonstrating the value of myocardial perfusion SPECT imaging in patients after PCI, there is still debate on whether or not these tests should be performed routinely.

Comparison of the Diagnostic Performance of Myocardial Perfusion Scintigraphy with and Without Attenuation Correction

“…Our method using the semi-quantitative assessment might have limitation in the assessment of multi-vessel diseases, however, the dynamic Tc-99m-sestamibi MPS for quantitative assessment of myocardial blood flow was not widely performed because of the low count sensitivity of the conventional SPECT scanner ( 22 ). Another potential weakness in our study was MPS may exhibit defects in the absence of stenoses when MPS was performed after angioplasty or stenting thus the specificity of MPS following PCI might be limited ( 23 ). Apart from CAD diagnosis, the parameters from the MPS were found to have prognostic value in the long-term period in patients having CAD regardless of ICA findings; for examples, abnormal MPS, especially in AC images, was associated with higher number of cardiac events, worsening survival rate and increased rate of hospital admission ( 24 , 25 , 26 ).…”

Clinical Significance of Tetrofosm in Extracardiac Uptake During Myocardial Perfusion Imaging

“…Information gained from post-intervention myocardial SPECT is important to differentiate patients with angina from those with exo-cardiac chest pain syndromes, to assess peri-intervention myocardial damage/acute vessel closure, to predict-detect restenosis after PCI and graft occlusion/stenosis after CABG surgery, to detect CAD progression in non-revascularized vessels, to assess left ventricular function (gated-SPECT), to evaluate the effects of intervention if required for occupational reasons and to predict patients' long-term prognosis. With respect to detect graft patency, MPS has a 80-96% sensitivity and 61-88% specificity, while regarding restenosis after PCI, sensitivity and specificity range between 74-94% and 67-88%, respectively (Georgoulias et al, 1998(Georgoulias et al, , 2010b. Specifically, using Tc99m tetrofosmin as the radiotracer, we have reported a sensitivity, specificity, positive and negative predictive value of MPI in detecting restenosis of 81.3%, 88%, 81.3% and 88%, respectively, whereas for the detection of restenosis in specific vessel, the corresponding values were 81.3%, 90%, 76.5% and 89.7%, respectively (Georgoulias et al, 1998(Georgoulias et al, , 2010b.…”

“…With respect to detect graft patency, MPS has a 80-96% sensitivity and 61-88% specificity, while regarding restenosis after PCI, sensitivity and specificity range between 74-94% and 67-88%, respectively (Georgoulias et al, 1998(Georgoulias et al, , 2010b. Specifically, using Tc99m tetrofosmin as the radiotracer, we have reported a sensitivity, specificity, positive and negative predictive value of MPI in detecting restenosis of 81.3%, 88%, 81.3% and 88%, respectively, whereas for the detection of restenosis in specific vessel, the corresponding values were 81.3%, 90%, 76.5% and 89.7%, respectively (Georgoulias et al, 1998(Georgoulias et al, , 2010b.…”