ArticleThe international journal of cardiovascular imaging2026
The value of myocardial perfusion CZT-SPECT in the assessment of coronary microvascular dysfunction in INOCA patients: a comparative study with caIMR.
Article in The international journal of cardiovascular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn this exploratory diagnostic study, although our previous study demonstrated the strong prognostic value of CZT-SPECT-derived stress myocardial blood flow (sMBF) and myocardial flow reserve (MFR) in patients with ischemia and non-obstructive coronary artery disease (INOCA), their diagnostic value and optimal cut-off values for coronary microvascular dysfunction (CMD) remain unclear.
methodsWe prospectively recruited 56 INOCA patients referred from cardiovascular medicine to nuclear medicine. Each underwent CZT-SPECT and coronary angiography-derived index of microcirculatory resistance (caIMR) within one week. CMD was defined as caIMR > 25 U. Bonferroni correction was applied for multiple comparisons of regional coronary physiological parameters.
resultsBased on caIMR, CMD was present in 42 INOCA patients (75%). After correction, regional MFR (LAD: 2.9 ± 0.9 vs. 3.7 ± 0.7, p =0.02; LCX: 2.8 ± 1.0 vs. 4.0 ± 1.5, p = 0.02; RCA: 2.9 ± 1.1 vs. 3.9 ± 0.7, p = 0.04) and global MFR (3.0 ± 0.9 vs. 3.9 ± 0.8, p < 0.01) were significantly lower in the CMD group, while no significant difference was observed in regional sMBF. Only global sMBF (r=-0.43, p < 0.01) and global MFR (r=-0.32, p = 0.02) showed moderate inverse correlations with caIMR. The optimal diagnostic cut-offs were global sMBF ≤ 3.8 mL/min/g (AUC = 0.68, 95%CI 0.55-0.80, p = 0.02) and global MFR ≤ 2.9 (AUC = 0.80, 95%CI 0.68-0.90, p < 0.01). DeLong test showed no statistically significant difference in diagnostic efficacy between the two parameters (95%CI for AUC difference: -0.06 to 0.30, p = 0.19). Conclusions These preliminary results demonstrate that CZT-SPECT-derived global sMBF and MFR provide modest diagnostic accuracy for identifying CMD in INOCA patients. This non-invasive approach may support identification of CMD and help guide clinical decision-making.
trial registrationChiCTR2000037112. Registered 27 August 2022, https://www.chictr.org.cn/.
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