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Incremental Value of Assessment of Regional Wall Motion for Detection of Multivessel Coronary Artery Disease in Exercise ²⁰¹Tl Gated Myocardial Perfusion Imaging

¹ Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
² Department of Nuclear Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan

Assessment of reversible perfusion defects in exercise ²⁰¹Tl perfusion SPECT has low sensitivity and high specificity for detection of multivessel coronary artery disease (CAD). The goal of this study was to evaluate whether worsening of left ventricular regional wall motion assessed by an automated algorithm in exercise ²⁰¹Tl electrocardiography-gated SPECT had incremental diagnostic value over perfusion data for detection of multivessel CAD. Methods: Two hundred one patients underwent exercise ²⁰¹Tl gated SPECT. Software that automatically analyzes left ventricular function was used to assess exercise and rest regional wall motion. Regional wall motion on initial images was compared with that on rest images, that is, delayed images for patients without reinjection images and reinjection images for patients with reinjection images. The left ventricle was divided into 9 segments, with individual segments assigned to 3 coronary territories. Worsening of wall motion was defined as worsening in any segment on initial images compared with rest images. Results: Of 73 patients with multivessel CAD, 20 (27.4%) had reversible perfusion defects in multiple coronary territories, 26 (35.6%) exhibited worsening of regional wall motion in multiple territories, and 37 (50.7%) had reversible perfusion defects or worsening of regional wall motion in multiple territories. The sensitivity of the combination of reversible perfusion defect and worsening of regional wall motion was significantly higher than that of reversible perfusion defect alone for detection of multivessel CAD (50.7% vs. 27.4%, P < 0.05). The specificity of the combination of reversible perfusion defect and worsening of regional wall motion for detecting multivessel CAD did not differ from that of reversible perfusion defect alone and that of worsening of regional wall motion alone (94.5% vs. 99.2% and 97.7%, respectively, P = not statistically significant). Conclusion: Combined assessment of worsening of left ventricular regional wall motion by exercise and perfusion data in exercise ²⁰¹Tl gated myocardial SPECT was more sensitive, with acceptable specificity, than was assessment with perfusion data alone for detection of multivessel CAD.

Key Words: ²⁰¹Tl • coronary artery disease • left ventricular function

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