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Background <p>Myocardial flow reserve (MFR), derived from dynamic single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), offers quantitative insight into coronary physiology and may overcome limitations of conventional semi-quantitative SPECT. We aimed to systematically review and meta-analyse the diagnostic accuracy and prognostic value of SPECT-derived MFR in comparison with invasive coronary angiography (ICA), PET-MPI, and long-term patient outcomes.</p> Results <p>A comprehensive literature search was done in scientific databases for studies comparing SPECT-derived MFR in patients with known or suspected coronary artery disease to ICA, PET-MPI, or ≥ 12-month follow-up for major adverse cardiac events. A meta-analysis was conducted using random-effects models for studies comparing SPECT-MFR with PET-MPI, and reporting diagnostic performance metrics including sensitivity and specificity. Thirty-two studies were included (<i>n</i> = 19 for ICA; <i>n</i> = 8 for PET-MPI; 1 for both ICA and PET-MPI and <i>n</i> = 4 for follow-up). Thirty studies showed a significant correlation between SPECT-derived MFR and reference standards with excellent area under the curve values (AUC &gt; 0.7) reported. Six PET-MPI comparator studies (with a total number of participants, <i>n</i> = 180) were included in the meta-analysis, yielding a pooled sensitivity of 78.5% (95% CI: 71.7–84.1%) and specificity of 89.3% (95% CI: 70.4–96.7%) (diagnostic odds ratio = 15.7 (95% CI: 6.270-39.269)). MFR consistently predicted major adverse cardiac events in prognostic studies, independent of obstructive coronary status.</p> Conclusions <p>Quantitative MFR derived from dynamic SPECT-MPI correlates well with established diagnostic reference tests and independently predicts adverse outcomes. While PET remains the reference standard, SPECT-MPI offers a viable and more accessible alternative. Standardised protocols and large-scale prospective validation are needed to optimise its clinical implementation.</p> PROSPERO registration <p>CRD42024507703.</p>

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Diagnostic and prognostic value of myocardial flow reserve quantification with single photon emission computed tomography – a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月28日

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  • Barnabás Baksa,
  • Sreeyapureddy Surendranath Reddy,
  • Sára Bundula,
  • Kristóf Nagy,
  • Samuel Beke,
  • Lili Száraz,
  • Tamás Györke,
  • Pál Maurovich-Horvat

摘要

Background

Myocardial flow reserve (MFR), derived from dynamic single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), offers quantitative insight into coronary physiology and may overcome limitations of conventional semi-quantitative SPECT. We aimed to systematically review and meta-analyse the diagnostic accuracy and prognostic value of SPECT-derived MFR in comparison with invasive coronary angiography (ICA), PET-MPI, and long-term patient outcomes.

Results

A comprehensive literature search was done in scientific databases for studies comparing SPECT-derived MFR in patients with known or suspected coronary artery disease to ICA, PET-MPI, or ≥ 12-month follow-up for major adverse cardiac events. A meta-analysis was conducted using random-effects models for studies comparing SPECT-MFR with PET-MPI, and reporting diagnostic performance metrics including sensitivity and specificity. Thirty-two studies were included (n = 19 for ICA; n = 8 for PET-MPI; 1 for both ICA and PET-MPI and n = 4 for follow-up). Thirty studies showed a significant correlation between SPECT-derived MFR and reference standards with excellent area under the curve values (AUC > 0.7) reported. Six PET-MPI comparator studies (with a total number of participants, n = 180) were included in the meta-analysis, yielding a pooled sensitivity of 78.5% (95% CI: 71.7–84.1%) and specificity of 89.3% (95% CI: 70.4–96.7%) (diagnostic odds ratio = 15.7 (95% CI: 6.270-39.269)). MFR consistently predicted major adverse cardiac events in prognostic studies, independent of obstructive coronary status.

Conclusions

Quantitative MFR derived from dynamic SPECT-MPI correlates well with established diagnostic reference tests and independently predicts adverse outcomes. While PET remains the reference standard, SPECT-MPI offers a viable and more accessible alternative. Standardised protocols and large-scale prospective validation are needed to optimise its clinical implementation.

PROSPERO registration

CRD42024507703.