Effects of gender and defect reversibility on detection of coronary disease with an upright and supine cadmium-zinc-telluride camera

  • Muhammad W. Athar
  • Fahad Waqar
  • Alok K. Dwivedi
  • Saad Ahmad
  • Saagar Sanghvi
  • Elonia Scott
  • Naseer Khan
  • Myron C. GersonEmail author
Original Article



Limited data address the roles of gender, perfusion defect reversibility, and imaging position in interpretation of images acquired on an upright/supine cadmium-zinc-telluride (CZT) cardiac imaging system.

Methods and Results

From a consecutive cohort of patients imaged on an upright/supine CZT camera, 260 patients with coronary angiograms were studied. Multivariable models identified gender as a significant effect modifier for imaging variables of CAD. For males, a supine summed stress score (SSS) ≥ 3 provided high accuracy (sensitivity 70.7%, specificity 72.2%), and highest contribution to multivariable models. In females, supine SSS ≥ 2 provided the best cut-off for defect size and severity (sensitivity 90%, specificity 35.9%), but specificity was improved substantially to 53.3% with decrease in sensitivity to 80% by also requiring quantitative identification of perfusion defect reversibility in the supine position. Eight variables, accurate for predicting coronary disease, were more accurate with supine than upright imaging.


Perfusion defect reversibility improved specificity in female patients for detection of coronary disease compared to perfusion defect size and extent alone. Supine images provided superior accuracy for detection of coronary disease compared to upright images.





Single-photon emission computerized tomography


Summed stress score

Combined SSS

Combined summed stress score (SSS ≥ 3 both supine and upright, or SSS ≥ 5 in either upright or supine position)

Supine SSS

Summed stress score in supine position


Summed rest score


Summed difference score


Summed rest percentage


Summed stress percentage


Total quantitative change in defect reversibility in the entire left ventricle


QREV in the supine position



The authors thank Marge Duke for her invaluable assistance with the data management.


None of the above authors have any conflicts of interest.

Supplementary material

12350_2019_1878_MOESM1_ESM.tif (4.7 mb)
Supplementary material 1 Supplemental Fig. 1 Receiver operating curves for male model 2 and female model 2 (TIFF 4841 kb)
12350_2019_1878_MOESM2_ESM.pptx (225 kb)
Supplementary material 2 (PPTX 225 kb)


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Copyright information

© American Society of Nuclear Cardiology 2019

Authors and Affiliations

  • Muhammad W. Athar
    • 1
  • Fahad Waqar
    • 1
  • Alok K. Dwivedi
    • 2
  • Saad Ahmad
    • 1
  • Saagar Sanghvi
    • 3
  • Elonia Scott
    • 4
  • Naseer Khan
    • 1
  • Myron C. Gerson
    • 1
    Email author
  1. 1.Division of Cardiovascular Health and Disease, Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnatiUSA
  2. 2.Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of MedicineTexas Tech University Health Sciences Center El PasoEl PasoUSA
  3. 3.Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnatiUSA
  4. 4.Division of Nuclear Medicine, Department of RadiologyUniversity of Cincinnati Medical CenterCincinnatiUSA

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