The potential of dynamic 99mTc-sestamibi cadmium zinc telluride-single-photon emission computed tomography camera assessing myocardial flow reserve in patients with heart failure with preserved ejection fraction

Satoya Yoshida; Kazumasa Unno; Mamoru Nanasato; Takanaga Niimi; Kohei Inukai; Hidenori Morisaki; Tomoki Hattori; Miku Hirose; Takumi Hayashi; Noriya Uchida; Masahiro Simoda; Hideo Oishi; Monami Ando; Kenshi Hirayama; Masaki Takenaka; Mayuho Maeda; Ruka Yoshida; Yasuhiro Ogura; Hirohiko Suzuki; Kenji Furusawa; Ryota Morimoto; Katsuhiko Kato; Satoshi Isobe; Yukihiko Yoshida; Toyoaki Murohara

doi:10.1093/ehjopen/oead028

The potential of dynamic ^99mTc-sestamibi cadmium zinc telluride-single-photon emission computed tomography camera assessing myocardial flow reserve in patients with heart failure with preserved ejection fraction

Eur Heart J Open. 2023 Mar 14;3(2):oead028. doi: 10.1093/ehjopen/oead028. eCollection 2023 Mar.

Authors

Satoya Yoshida^{1

2}, Kazumasa Unno^{1

2}, Mamoru Nanasato³, Takanaga Niimi⁴, Kohei Inukai¹, Hidenori Morisaki¹, Tomoki Hattori¹, Miku Hirose^{1

2}, Takumi Hayashi^{1

2}, Noriya Uchida¹, Masahiro Simoda¹, Hideo Oishi^{1

2}, Monami Ando¹, Kenshi Hirayama¹, Masaki Takenaka¹, Mayuho Maeda¹, Ruka Yoshida^{1

2}, Yasuhiro Ogura¹, Hirohiko Suzuki¹, Kenji Furusawa², Ryota Morimoto², Katsuhiko Kato⁵, Satoshi Isobe², Yukihiko Yoshida¹, Toyoaki Murohara²

Affiliations

¹ Cardiovascular Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi 466-8650, Japan.
² Department Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, showa-ku, Nagoya, Aichi 466-8560, Japan.
³ Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan.
⁴ Division of Nuclear Medicine, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-cho, Sowa-ku, Nagoya, Aichi 466-8650, Japan.
⁵ Department of Radiology, Nagoya University Hospital, 65 Tsurumai-cho, showa-ku, Nagoya, Aichi 466-8560, Japan.

Abstract

Aims: Coronary microvascular dysfunction (CMD) is related to the pathophysiology, mortality, and morbidity of heart failure with preserved ejection fraction (HFpEF). A novel single-photon emission computed tomography (SPECT) camera with cadmium zinc telluride (CZT) detectors allows for the quantification of absolute myocardial blood flow and myocardial flow reserve (MFR) in patients with coronary artery disease. However, the potential of CZT-SPECT assessing for CMD has never been evaluated in patients with HFpEF.

Methods and results: The clinical records of 127 consecutive patients who underwent dynamic CZT-SPECT were retrospectively reviewed. Rest and stress scanning were started simultaneously with 3 and 9 MBq/kg of ⁹⁹mTc-sestamibi administration, respectively. Dynamic CZT-SPECT imaging data were analysed using a net-retention model with commercially available software. Transthoracic echocardiography was performed in all patients. The MFR value was significantly lower in the HFpEF group (mean ± SEM = 2.00 ± 0.097) than that in the non-HFpEF group (mean ± SEM = 2.74 ± 0.14, P = 0.0004). A receiver operating characteristic analysis indicated that if a cut-off value of 2.525 was applied, MFR could efficiently distinguish HFpEF from non-HFpEF. Heart failure with preserved ejection fraction had a consistently low MFR, regardless of the diastolic dysfunction score. Heart failure with preserved ejection fraction patients with MFR values lower than 2.075 had a significantly higher incidence of heart failure exacerbation.

Conclusion: Myocardial flow reserve assessed by CZT-SPECT was significantly reduced in patients with HFpEF. A lower MFR was associated with a higher hospitalization rate in these patients. Myocardial flow reserve assessed by CZT-SPECT has the potential to predict future adverse events and stratify the severity of disease in patients with HFpEF.

Keywords: Cadmium zinc telluride equipped single-photon emission computed tomography camera; Coronary microvascular dysfunction; Dynamic scanning; Heart failure with preserved ejection fraction; Myocardial blood flow; Myocardial flow reserve.