Diagnostic value of left ventricular dyssynchrony after exercise and at rest in the detection of multivessel coronary artery disease on single-photon emission computed tomography.

ABSTRACT

BACKGROUND: Although stress-induced left ventricular (LV) wall motion abnormality is a well-known marker for extensive coronary artery disease (CAD), no study has yet analyzed whether phase analysis of exercise-induced LV mechanical dyssynchrony may have enhanced diagnostic value over conventional perfusion analysis in the detection of multivessel CAD. METHODS AND RESULTS: A total of 278 patients with suspected or confirmed CAD underwent both exercise stress (99m)Tc-sestamibi gated single-photon emission computed tomography and coronary angiography. LV mechanical dyssynchrony was evaluated using the SyncTool to obtain the phase SD and histogram bandwidth. In the detection of 128 patients with multivessel CAD, a summed stress score (SSS) of ≥9 showed a sensitivity of 84% and a specificity of 53%, while an increase in phase SD of ≥4.4° and a bandwidth of ≥14° after exercise had sensitivities of 74% and 68%, and specificities of 84% and 91%, respectively. On multivariate analysis the combination of post-stress increases in phase SD, histogram bandwidth, transient ischemic dilation (TID) ratio and SSS best identified multivessel CAD (sensitivity 77%, specificity 88%, χ(2)=181.8), compared with TID ratio and SSS only (sensitivity 70%, specificity 76%, χ(2)=68.9). CONCLUSIONS: The addition of phase analysis to evaluate exercise-induced LV mechanical dyssynchrony on conventional perfusion analysis enabled better identification of patients with multivessel CAD.