Value of early rest myocardial perfusion imaging with SPECT in patients with chest pain and non-diagnostic ECG in emergency department

  • Mohammadreza Taban Sadeghi
  • Babak Mahmoudian
  • Samad Ghaffari
  • Payman Moharamzadeh
  • Alireza Ala
  • Leili Pourafkari
  • Shahla Gureishi
  • Neda Roshanravan
  • Somayeh Abolhasani
  • Mahboub PouraghaeiEmail author
Original Paper


Evaluation of atypical presentation of angina chest pain in emergency department is difficult. Hospitalization of this patient may impose additional costs and waste the time, early discharge may lead to miss the patients. The aim of this study was to determine volubility of Single Photon Emission Computed Tomography (SPECT) in management of patients admitted to emergency department with atypical manifestations of angina pain, un-diagnostic Electrocardiogram (ECG) and negative enzyme. Half of 100 patients admitted to emergency department with atypical chest pain and un-diagnostic ECG who were candidate for admission, underwent ECG gated resting SPECT. According to the results of SPECT, low risk patient discharged after negative stress SPECT. All discharged patients were followed up for major cardiac events (cardiac death, nonfatal myocardial infarction and repeat admission for congestive heart failure) for 12 months. According to rest SPECT Myocardial Perfusion Imaging (MPI), about 70% of patients in case group was low risk and 30% of them had moderate or high risk. Case group represented lower hospitalization rate and lower need for Coronary Artery Angiography (CAG) in comparison with control group. Mean cost in case group was significantly lower than control group (175.15$ vs. 391.33$, P < 0.001). In one year follow- up no cases of mortality or major cardiovascular events as cardiac infraction were found in discharged patients in case group. our study showed that rest SPECT fulfillment in admitted patients in emergency department was validated method for assessing patients’ risk which avoids unnecessary hospitalizations and additional costs.


Chest pains SPECT scan Treatment cost 



The authors thank all of the patients who eagerly participated in the current study. The authors also wish to thank the Research Vice Chancellor of Tabriz University of Medical Sciences.


This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sector.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.


  1. 1.
    Willemsen RT, Buntinx F, Winkens B, Glatz JF, Dinant GJ (2014) The value of signs, symptoms and plasma heart-type fatty acid-binding protein (H-FABP) in evaluating patients presenting with symptoms possibly matching acute coronary syndrome: background and methods of a diagnostic study in primary care. BMC Fam Pract 15(1):203CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Marill KA (2017) Identifying emergency department patients with chest pain who are at low risk for acute coronary syndromes. Emerg Med Pract 19(7):1–24Google Scholar
  3. 3.
    Weinstock MB, Weingart S, Orth F, VanFossen D, Kaide C, Anderson J, Newman DH (2015) Risk for clinically relevant adverse cardiac events in patients with chest pain at hospital admission. JAMA Intern Med 175(7):1207–1212CrossRefPubMedGoogle Scholar
  4. 4.
    Rao MP, Panduranga P, Al-Mukhaini M, Sulaiman K, Al-Jufaili M (2012) Predictive value of a 4-hour accelerated diagnostic protocol in patients with suspected ischemic chest pain presenting to an emergency department. Oman Med J 27(3):207CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ricci B, Cenko E, Varotti E, Puddu PE, Manfrini O (2016) Atypical chest pain in ACS: a trap especially for women. Curr Pharm Des 22(25):3877–3884CrossRefPubMedGoogle Scholar
  6. 6.
    Riley RF, Miller CD, Russell GB, Harper EN, Hiestand BC, Hoekstra JW, Lefebvre CW, Nicks BA, Cline DM, Askew KL (2017) Cost analysis of the History, ECG, Age, risk factors, and initial troponin (HEART) pathway randomized control trial. Am J Emerg Med 35(1):77–81CrossRefPubMedGoogle Scholar
  7. 7.
    Tewelde SZ, Mattu A, Brady WJ Jr (2017) Pitfalls in electrocardiographic diagnosis of acute coronary syndrome in low-risk chest pain. W J Emerg Med 18(4):601CrossRefGoogle Scholar
  8. 8.
    Esteban LF, Ferrer MM, Martínez GG, Cantador JR, De Pablo C, Curto LM (2008) Utility of myocardial perfusion SPECT for evaluation of patients from chest pain unit. Rev Esp Med Nucl 27(2):90–98CrossRefGoogle Scholar
  9. 9.
    Gimelli A, Rossi G, Landi P, Marzullo P, Iervasi G, L’Abbate A, Rovai D (2009) Stress/rest myocardial perfusion abnormalities by gated SPECT: still the best predictor of cardiac events in stable ischemic heart disease. J Nucl Med 50(4):546CrossRefPubMedGoogle Scholar
  10. 10.
    Ben-Gal T, Zafrir N (2001) The utility and potential cost-effectiveness of stress myocardial perfusion thallium SPECT imaging in hospitalized patients with chest pain and normal or non-diagnostic electrocardiogram. IMAJ-RAMAT GAN- 3(10):725–730Google Scholar
  11. 11.
    Husmann L, Herzog BA, Gaemperli O, Tatsugami F, Burkhard N, Valenta I, Veit-Haibach P, Wyss CA, Landmesser U, Kaufmann PA (2008) Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating. Eur Heart J 30(5):600–607CrossRefPubMedGoogle Scholar
  12. 12.
    Candell-Riera J, Oller-Martínez G, Pereztol-Valdés O, Castell-Conesa J, Aguadé-Bruix S, García-Alonso C, Segura R, Murillo J, Moreno R, Suriñach J (2004) Early myocardial perfusion gated-SPECT in patients with chest pain and non-diagnostic ECG in the emergency department. Rev Esp Cardiol 57(3):225–233CrossRefPubMedGoogle Scholar
  13. 13.
    Stowers SA, Eisenstein EL, Berman DS, Blackshear JL, Jones AD Jr, Szymanski TJ Jr, Lam LC, Simons TA, Natale D, Paige KA (2000) An economic analysis of an aggressive diagnostic strategy with single photon emission computed tomography myocardial perfusion imaging and early exercise stress testing in emergency department patients who present with chest pain but nondiagnostic electrocardiograms: results from a randomized trial. Ann Emerg Med 35(1):17–25CrossRefPubMedGoogle Scholar
  14. 14.
    Udelson JE, Beshansky JR, Ballin DS, Feldman JA, Griffith JL, Heller GV, Hendel RC, Pope JH, Ruthazer R, Spiegler EJ (2002) Myocardial perfusion imaging for evaluation and triage of patients with suspected acute cardiac ischemia: a randomized controlled trial. JAMA 288(21):2693–2700CrossRefPubMedGoogle Scholar
  15. 15.
    Matsumoto N, Sato Y, Suzuki Y, Kasama S, Nakano Y, Kato M, Yoda S, Miki T, Iida J, Kunimasa T (2008) Incremental prognostic value of cardiac function assessed by ECG-gated myocardial perfusion SPECT for the prediction of future acute coronary syndrome. Circ J 72(12):2035–2039CrossRefPubMedGoogle Scholar
  16. 16.
    Erhardt L, Herlitz J, Bossaert L, Halinen M, Keltai M, Koster R, Marcassa C, Quinn T, Van Weert H (2002) Task force on the management of chest pain. Eur Heart J 23(15):1153–1176CrossRefPubMedGoogle Scholar
  17. 17.
    Lee TH, Goldman L (2000) Evaluation of the patient with acute chest pain. N Engl J Med 342(16):1187–1195CrossRefPubMedGoogle Scholar
  18. 18.
    Goodacre S, Cross E, Lewis C, Nicholl J, Capewell S (2007) Effectiveness and safety of chest pain assessment to prevent emergency admissions: ESCAPE cluster randomised trial. BMJ 335(7621):659CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Sanchis J, Bodí V, Núñez J, Bertomeu-González V, Gómez C, Bosch MJ, Consuegra L, Bosch X, Chorro FJ, Llàcer À (2005) New risk score for patients with acute chest pain, non-ST-segment deviation, and normal troponin concentrations: a comparison with the TIMI risk score. J Am Coll Cardiol 46(3):443–449CrossRefPubMedGoogle Scholar
  20. 20.
    Elhendy A, Schinkel AF, van Domburg RT, Bax JJ (2005) Risk stratification of patients with angina pectoris by stress^ sup 99m^ Tc-tetrofosmin myocardial perfusion imaging. J Nucl Med 46(12):2003PubMedGoogle Scholar
  21. 21.
    Fesmire FM, Hughes AD, Fody EP, Jackson AP, Fesmire CE, Gilbert MA, Stout PK, Wojcik JF, Wharton DR, Creel JH (2002) The Erlanger chest pain evaluation protocol: a one-year experience with serial 12-lead ECG monitoring, two-hour delta serum marker measurements, and selective nuclear stress testing to identify and exclude acute coronary syndromes. Ann Emerg Med 40(6):584–594CrossRefPubMedGoogle Scholar
  22. 22.
    Conti A, Zanobetti M, Grifoni S, Berni G, Costanzo E, Gallini C, Ferri P, Pieroni C (2003) Implementation of myocardial perfusion imaging in the early triage of patients with suspected acute coronary syndromes. Nucl Med Commun 24(10):1055–1060CrossRefPubMedGoogle Scholar
  23. 23.
    Abbott B, Jain D (2003) Impact of myocardial perfusion imaging on clinical management and the utilization of hospital resources in suspected acute coronary syndromes. Nucl Med Commun 24(10):1061–1069CrossRefPubMedGoogle Scholar
  24. 24.
    Azevedo JC, Félix RC, Corrêa PL, Barbirato GB, Dohmann HF, Silva PR, Mesquita ET, Mesquita CT (2007) Medium term prognostic value of stress myocardial perfusion scintigraphy in a chest pain unit. Arq Bras Cardiol 88(5):602–610CrossRefPubMedGoogle Scholar
  25. 25.
    Forberg JL, Hilmersson CE, Carlsson M, Arheden H, Björk J, Hjalte K, Ekelund U (2009) Negative predictive value and potential cost savings of acute nuclear myocardial perfusion imaging in low risk patients with suspected acute coronary syndrome: a prospective single blinded study. BMC Emerg Med 9(1):12CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Neumann PJ, Rosen AB, Weinstein MC (2005) Medicare and cost-effectiveness analysis. N Engl J Med 353(14):1516CrossRefPubMedGoogle Scholar
  27. 27.
    Otero HJ, Rybicki FJ, Greenberg D, Mitsouras D, Mendoza JA, Neumann PJ (2010) Cost-effective diagnostic cardiovascular imaging: when does it provide good value for the money? Int J Cardiovasc Imaging 26(6):605–612CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Kontos MC, Schmidt KL, McCue M, Rossiter LF, Jurgensen M, Nicholson CS, Jesse RL, Ornato JP, Tatum JL (2003) A comprehensive strategy for the evaluation and triage of the chest pain patient: a cost comparison study. J Nucl Cardiol 10(3):284–290CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Mohammadreza Taban Sadeghi
    • 1
  • Babak Mahmoudian
    • 2
  • Samad Ghaffari
    • 1
  • Payman Moharamzadeh
    • 3
  • Alireza Ala
    • 3
  • Leili Pourafkari
    • 1
  • Shahla Gureishi
    • 3
  • Neda Roshanravan
    • 1
  • Somayeh Abolhasani
    • 1
  • Mahboub Pouraghaei
    • 3
    Email author
  1. 1.Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
  2. 2.Medical Radiation Sciences Research TeamTabriz University of Medical SciencesTabrizIran
  3. 3.Emergency Medical Research TeamTabriz University of Medical SciencesTabrizIran

Personalised recommendations