Non-invasive diagnosis of coronary artery disease by 123I-BMIPP/201TlCl dual myocardial SPECT in patients with heart failure

- Non-invasive diagnostic tool to detect coronary artery disease (CAD) is required.
- Uptake mismatch of 123I-BMIPP and 201TlCl was an effective marker in detecting CAD.
- 123I-BMIPP/201TlCl dual SPECT is a useful non-invasive procedure in detecting CAD.

Background/objectivesDetecting the presence of coronary artery disease (CAD) is critically important in managing patients with heart failure of uncertain cause. The recently introduced 123I-BMIPP/201TlCl dual myocardial single-photon emission computed tomography (dual SPECT) is potentially a non-invasive diagnostic tool in detecting ischemic heart disease. The aim of our study is to evaluate the efficacy of detecting CAD by dual SPECT in patients with heart failure.MethodsWe studied 501 consecutive patients (366 males, mean age 68 ± 12 years) who were admitted because of heart failure between January 2005 and April 2009. In all patients, the dual SPECT was performed in clinically stabilized states, followed by coronary angiography within 1 week. The polar map of the SPECT image was divided into 17 segments, each scored on a scale of 0-4 based on segmental percent uptake. The mismatch score was defined as the difference between 123I-BMIPP defect score and 201TlCI defect score. The uptake of 201TlCl and 123I-BMIPP was analyzed quantitatively using the Heart Score View software.ResultsThe 201TlCI defect score and mismatch score were significantly higher in CAD patients than in non-CAD patients. The receiver operating characteristic (ROC) curve revealed that the mismatch score was a significantly more effective marker in detecting the presence of CAD than 201TlCl defect score (area under the curve: 0.84 versus 0.73, p < 0.05). Using the mismatch score, the sensitivity and specificity of dual SPECT in detecting CAD were 84% and 83%, respectively.ConclusionDual SPECT is a useful non-invasive procedure for the detection of CAD in patients with heart failure.