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Assessing the diagnostic value of left ventricular synchrony indices derived from phase analysis by D-SPECT in identifying obstructive coronary artery disease

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Abstract

This study aimed to assess the diagnostic efficacy of left ventricular synchrony (LVS) for detecting coronary artery disease (CAD). We explored whether the LVS index derived from phase analysis of D-SPECT provides superior diagnostic value compared to conventional perfusion analysis in identifying obstructive CAD. Patients with suspected or confirmed CAD underwent drug-stress/rest gated D-SPECT myocardial perfusion imaging (MPI) and coronary angiography (CAG). A 50% stenosis was set as the threshold for obstructive CAD. 110 participants were enrolled in this analysis. There were significant differences in phase standard deviation (PSD), phase histogram bandwidth (PHB) and entropy among the four groups. Patients without cardiac disease and those with mild-moderate stenosis exhibited no noticeable contraction asynchrony. However, LVS indices demonstrated a gradual increase with the progression of coronary stenosis when compared to NC (P < 0.001). Obstructive CAD was identified in 43 out of 110 participants (39%). Optimal cutoff values for diagnosing obstructive CAD during stress were determined as 7.6° for PSD, 24° for PHB, and 37% for entropy, respectively. Notably, PSD, PHB, and entropy indices exhibited higher sensitivity compared to MPI. The integration of the stress-induced LVS indices into routine MPI analysis resulted in a significantly greater area under the curve (AUC), leading to improved diagnostic performance and enhanced differential capacity. Stress-induced LVS indices increase with the severity of coronary artery stenosis by D-SPECT phase analysis. Further, the indices-derived phase analysis exhibits superior sensitivity and discriminatory ability compared to MPI in detecting obstructive CAD.

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Data availability

All data generated or analyzed during this study are included in this article or its online supplementary material files. Further enquiries can be directed to the corresponding author.

Abbreviations

CAD:

Coronary artery disease

CZT:

Cadmium zinc telluride

LVS:

Left ventricular synchrony

SSS:

Summed stress score

MPI:

Myocardial perfusion imaging

SDS:

Summed difference score

CAG:

Coronary angiography

ROI:

Region of interest

PSD:

Phase standard deviation

AUC:

Area under the curve

PHB:

Phase histogram bandwidth

LVF:

Left ventricular function

SPECT:

Single photon emission computed tomography

ECG:

Electrocardiogram

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Acknowledgements

We would like to express our gratitude to all researchers who participated in the study and the staff of PET/CT Center and Department of Cardiology at Gansu Provincial Hospital for their selfless help and valuable assistance. Thanks to the experts who provided professional advice.

Funding

This study was supported by the Natural Science Foundation of Gansu Province (21JR7RA633, 22JR5RA666).

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Author notes

  1. Fu Zhang and Hai-Jun Wang have contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Gansu Province, Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China

    **nhua Ding & Haijun Wang

  2. PET/CT Center, Gansu Provincial Hospital, Lanzhou, China

    Lanlan Cui

  3. Department of Cardiology, Gansu Province, Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China

    Jianfeng Li & Fu Zhang

  4. Department of Radiology, Gansu Provincial Hospital, Lanzhou, China

    Jiancang Cao

  5. School of Public Health, Shanxi Medical University, Taiyuan, China

    Mingjia Ding

  6. Department of Ultrasound, Gansu Provincial Hospital, Lanzhou, China

    Haiyong Wang

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Contributions

**nhua Ding, Lanlan Cui, Fu Zhang and Jiancang Cao were involved in the design of this study and contributed to the writing of manuscript. **nhua Ding, Lanlan Cui, Mingjia Ding performed clinical data collection and image interpretation. **nhua Ding, Jianfeng Li and Haiyong Wang performed data analysis. **nhua Ding wrote the first draft of the manuscript. Fu Zhang and Haijun Wang provided critical revisions to the manuscript for important content. The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.

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Correspondence to Fu Zhang or Haijun Wang.

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Ethical approval

The study conformed to the Declaration of Helsinki. The study was approved by Gansu Provincial Hospital Medical Ethics Committee (Batch number: 2023–394). All subjects provided signed informed consent.

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Ding, X., Cui, L., Li, J. et al. Assessing the diagnostic value of left ventricular synchrony indices derived from phase analysis by D-SPECT in identifying obstructive coronary artery disease. Int J Cardiovasc Imaging (2024). https://doi.org/10.1007/s10554-024-03182-z

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