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. 2009 Dec 14;32(12):E11–E15. doi: 10.1002/clc.20534

Single‐Photon Emission Computed Tomography Myocardial Perfusion Imaging in the Diagnosis of Left Main Disease

Luis Afonso 1,✉, Nitin Mahajan 2
PMCID: PMC6653516  PMID: 20014205

Abstract

Background

Left main disease (LMD), defined as ≥ 50% lesion stenosis, occurs in 3% to 5% of patients undergoing catheterization. Limited data on the value of single‐photon emission computed tomography (SPECT) imaging for diagnosis of LMD exists.

Hypothesis

This study sought to evaluate the diagnostic accuracy of SPECT imaging in the diagnosis of LMD.

Methods

A total of 74 consecutive patients with LMD, identified from our catheterization lab database (January 2003–December 2007) with gated exercise (15 patients) or adenosine (59 patients), thallium 201, or Tc‐99m SPECT imaging within 6 months of index angiography were included. Group 1 (Gp 1) included 33 patients with isolated LMD. Group 2 (Gp 2) consisted of 41 patients with LMD and 1‐vessel disease (6); LMD and 2‐vessel disease (24); and LMD and 3‐vessel disease (11).

Results

Reversible perfusion defects (PD) were absent in 6 (18%) of Gp 1 and 8 (20%) of Gp 2 patients. Among Gp 1 patients, PD in 1‐vessel, 2‐vessel, 3‐vessel distribution were seen in 20 (61%), 5 (15%), and 2 (6%) patients respectively. In comparison, PD in 1‐vessel, 2‐vessel, 3‐vessel distribution were observed in 20 (49%), 12 (29%), and 1 (2%) of Gp 2 patients respectively. Left main (LM) pattern was noted in 6 patients (Gp 1: 2, Gp 2: 4). Transient ischemic dilatation (TID) was encountered in 34 patients (Gp 1: 17, Gp 2: 17) and in 4 patients with normal perfusion scans.

Conclusions

These data represent the largest analysis of patients with “isolated” LMD. Approximately 19% of patients with LMD have no reversible PD on SPECT. While LM pattern is rare, 1‐vessel distribution PD and TID represent the most frequent SPECT abnormalities. Copyright © 2009 Wiley Periodicals, Inc.

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