Abstract
The noninvasive differentiation between ischemic and nonischemic cardiomyopathy is
frequently difficult. We examined the clinical value of stress electrocardiographic
gated (ECG-gated) single-photon emission computed tomography (SPECT) to identify ischemic
cardiomyopathy and detect coronary artery disease (CAD) in 164 patients without known
CAD, ejection fraction ≤40% by ECG-gated SPECT, and subsequent coronary angiography.
Summed stress, rest, and difference scores were measured from the SPECT studies, and
regional wall motion variance was calculated from the ECG-gated images. Sensitivity
and 95% confidence intervals for the diagnosis of ischemic cardiomyopathy and for
detection of any CAD (>50% diameter stenosis) were estimated using previously defined
cutoffs for summed stress score and regional wall motion variance. For the diagnosis
of ischemic cardiomyopathy, sensitivity of stress SPECT (summed stress score >8) was
87% (95% confidence interval [CI] 78 to 95), with a specificity of 63% (95% CI 60
to 82). The addition of wall motion information (summed stress score >8 or regional
wall motion variance >0.114) increased sensitivity to 88% (95% CI 80 to 96) and decreased
specificity to 45% (95% CI 35 to 55). If reversibility was also taken into account
(summed stress score >8, regional wall motion variance >0.114, or summed difference
score >0), sensitivity further increased to 94% (95% CI 88 to 100) and specificity
decreased to 32% (95% CI 23 to 41). For detection of any CAD, the combined approach
using stress perfusion, reversibility, and region of wall motion had a sensitivity
of 94% (95% CI 89 to 99) and a specificity of 45% (95% CI 35 to 57). Therefore, ECG-gated
SPECT is very sensitive for detection of ischemic cardiomyopathy and CAD among patients
with moderate to severe systolic dysfunction.
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Article info
Publication history
Accepted:
March 12,
2004
Received in revised form:
March 12,
2004
Received:
December 9,
2003
Footnotes
☆The study was supported in part by grants from the Hartford Hospital Research Fund, Hartford, Connecticut, and Bristol Myers Squibb Medical Imaging, Billerica, Massachusetts.
Identification
Copyright
© 2004 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
