Feasibility and accuracy of SPECT myocardial perfusion imaging in end-stage lung disease

Abstract

Background

Coronary artery disease (CAD) is associated with increased mortality in patients with chronic lung disease. However, non-invasive diagnostic of CAD is difficult, especially in patients with more advanced disease. Therefore, we aimed to assess the feasibility and accuracy of SPECT-myocardial perfusion imaging (MPI) stress testing with regadenoson in patients with end-stage lung disease (ELD) undergoing assessment of stable CAD.

Methods

Between January 2012 and May 2018, 102 patients with ELD, who were referred to our institution for lung transplant evaluation, were assessed retrospectively. All patients underwent both stress SPECT-MPI as well as coronary angiography.

Results

The mean age in our population was 57±6 years. All patients had severe pulmonary function impairment. During stress SPECT-MPI 14 patients (14%) reported regadenoson-related symptoms, but only 2 patients (2%) required medical treatment. Coronary angiography revealed obstructive CAD in 20 patients (20%). Among those, 5 patients had abnormal SPECT-MPI and PCI was performed in 3 patients accordingly. In 14 patients with obstructive CAD, revascularization was deferred based on normal SPECT-MPI findings.

Conclusions

SPECT-MPI using regadenoson is well tolerated in patients with ELD and can help to make decisions about coronary revascularization before lung transplant.

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Abbreviations

CAD:

Coronary artery disease

CAG:

Coronary angiography

CAC:

Coronary artery calcium score

COPD:

chronic obstructive pulmonary disease

ELD:

End-stage lung disease

FFR:

Fractional flow reserve

ILD:

Interstitial lung disease

MPI:

Myocardial perfusion imaging

RCA:

Right coronary artery

SPECT:

Single-photon emission computed tomography

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Correspondence to Sanziana R. I. Schiopu MD.

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Schiopu, S.R.I., Zacherl, M., Todica, A. et al. Feasibility and accuracy of SPECT myocardial perfusion imaging in end-stage lung disease. J. Nucl. Cardiol. 27, 903–911 (2020). https://doi.org/10.1007/s12350-019-01851-4

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Keywords

  • COPD
  • ILD
  • stress testing
  • coronary artery disease
  • myocardial perfusion imaging
  • SPECT