Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease

J Nucl Cardiol. 2007 Jul;14(4):521-8. doi: 10.1016/j.nuclcard.2007.05.008.


Background: There have been limited data regarding the value of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for the detection of left main coronary artery disease (CAD).

Methods and results: We studied 101 patients with angiographic left main CAD (> or = 50% stenosis) and no prior myocardial infarction or coronary revascularization who underwent gated exercise or adenosine stress technetium 99m sestamibi SPECT MPI. By perfusion assessment alone, high-risk disease with moderate to severe defects (> 10% myocardium at stress) was identified in only 56% of patients visually and 59% quantitatively. Absence of significant perfusion defect (> or = 5% myocardium) was seen in 13% of patients visually and 15% quantitatively. However, by combining visual perfusion data and nonperfusion variables, especially transient ischemic dilation, 83% of patients were identified as high risk.

Conclusions: The findings of this study demonstrate that assessment of perfusion data alone by visual or quantitative SPECT MPI analysis underestimates the magnitude of left main CAD. The combination of perfusion and nonperfusion abnormalities on gated MPI identifies high risk in most patients with left main CAD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angiography / methods
  • Coronary Angiography
  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / pathology*
  • Female
  • Heart / diagnostic imaging
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / diagnosis*
  • Myocardial Ischemia / pathology*
  • Perfusion
  • Radiopharmaceuticals / pharmacology
  • Technetium Tc 99m Sestamibi / pharmacology
  • Tomography, Emission-Computed, Single-Photon / instrumentation
  • Tomography, Emission-Computed, Single-Photon / methods*


  • Radiopharmaceuticals
  • Technetium Tc 99m Sestamibi