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

Background/objectives: Detecting the presence of coronary artery disease (CAD) is critically important in managing patients with heart failure of uncertain cause. The recently introduced I-123-BMIPP/(TlCl)-Tl-201 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. Methods: We 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 I-123-BMIPP defect score and (TlCI)-Tl-201 defect score. The uptake of (TlCl)-Tl-201 and I-123-BMIPP was analyzed quantitatively using the Heart Score View software. Results: The (TlCl)-Tl-201 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 (TlCl)-Tl-201 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. Conclusion: Dual SPECT is a useful non-invasive procedure for the detection of CAD in patients with heart failure. (C) 2014 Elsevier Ireland Ltd. All rights reserved.