Comparative analysis of standard indices of myocardial perfusion scintigraphy and quantitative indicators of myocardial dynamic single-photon emission computed tomography in patients with non-obstructive coronary artery disease

Aim. To compare standard indices of myocardial perfusion scintigraphy (MPS) and quantitative indicators of myocardial dynamic single-photon emission computed tomography (SPECT) in patients with non-obstructive coronary artery disease (NOCAD).

Material and methods. The study included patients with symptoms or signs of myocardial ischemia and NOCAD (<50%). All patients underwent dynamic myocardial SPECT with assessment of standard MPS indices (summed stress score (SSS), summed rest score (SRS), summed difference score (SDS)) and quantitative indicators (stress and rest myocardial blood flow (MBF), myocardial flow reserve (MFR) and stress/rest MBF difference (ΔMBF)).

Results. According to MPS, 15 (26%) patients had signs of myocardial perfusion dysfunction (SSS ≥2,0). Standard MPS indices had low values as follows: SSS 0,0 (0,0; 2,0), SRS 0,0 (0,0; 0,0), SDS 0,0 (0,0; 2,0). According to dynamic myocardial SPECT, 22 (38%) patients had a reduced MFR <2,0. Quantitative indicators were characterized by greater variability compared to the MPS data as follows: stress MBF 1,34 (1,03; 1,64) ml/min/g, rest MBF 0,58 (0,42; 0,73) ml/min/g, MFR 2,42 (1,48; 2,85), ΔMBF 0,68 (0,36; 1,09). In 7 (12%) patients, ischemic myocardial changes (SSS ≥2,0) was associated with a reduced MFR <2,0, and in 28 (48%) without signs of ischemia (SSS <2,0) the MFR was within normal values ≥2,0. However, 15 (26%) had a normal radiopharmaceutical distribution and a reduced MFR, which may indicate the initial stages of microvascular dysfunction, which did not lead to myocardial ischemia.

Conclusion. The dynamic SPECT allows in ~30% of cases to identify MBF and MFR disorders in NOCAD patients with normal results of standard SFM.

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