Early Detection of Myocardial Damages for Patients with Chest Pain and Non-Diagnostic ECG in Emergency Department by Rest Myocardial Perfusion Imaging: A Preliminary Study

Document Type: Original article


1 Bushehr Medical Heart Center, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran

2 The Persian Gulf Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy (MIRT), Bushehr Medical University Hospital, Bushehr University of Medical Sciences, Bushehr, Iran


Background: According to the World Health Organization (WHO), cardiovascular disease is the significant leading cause of mortality in adults. Some studies demonstrated that rest Myocardial Perfusion Imaging (rMPI) is a reliable test for ruling out myocardial ischemia/infarction in patients with inconclusive diagnostic data including non-diagnostic or normal Electrocardiogram (ECG) and troponin test result.
Methods: Patients who presented to the emergency department with chest pain underwent evaluation assay including inquiry about history, having abnormal ECG, troponin test result and physical examination. The patients with normal or non-diagnostic ECG and normal troponin were enrolled in our study. Then, they were referred to the department of nuclear medicine for rMPI. The patients with abnormal rMPI were asked to perform coronary angiography and the patients with normal rMPI were followed up for average of 12.8 months.
Results: In this study, 20 patients with mean age of 46.15±12.7 including 7 males and 13 felames were enrolled. Among 20 patients, 14 (70%) patients had normal rMPI and 6 (30%) were abnormal. All patients with abnormal rMPI showed coronary disorders in angiography. Rest of them with normal rMPI were followed up and no cases with cardiac events were found among them. Sensitivity, specificity, positive and negative predictive value for MPI was 100%. Conclusion: According to the data of this study, MPI has a good sensitivity and specificity for diagnosis of myocardial ischemia/infraction and the acute coronary syndrome that prevents unnesseray hospitalization. So, it can be included in the diagnostic protocol in emergency departments of developing countries.


1. Kyaw H,  Buddhavarapu S, Abboud J, Misra D. Uncertainty of myocardial perfusion imaging in chest pain risk stratification. Ochsner J 2017;17(2):208-12.
2. Balakumar P, Maung-U K, Jagadeesh G. Prevalence and prevention of cardiovascular disease and diabetes mellitus. Pharmacol Res 2016 Nov;113(Pt A):600-9.
3. Iida H, Eberl S. Quantitative assessment of regional myocardial blood flow with thallium-201 and SPECT. J Nucl Cardiol 1998 May-Jun;5(3):313-31
4. Gimelli A, Rossi G, Landi P, Marzullo P, Iervasi G, L’abbate A, et al. Stress/rest myocardial perfusion abnormalities by gated SPECT: still the best predictor of cardiac events in stable ischemic heart disease. J Nucl Med 2009 Apr;50(4):546-53.
5. Taban Sadeghi M, Mahmoudian B, Ghaffari S, Moharamzadeh P, Ala A, Pourafkari L, et al. Value of early rest myocardial perfusion imaging with SPECT in patients with chest pain and non-diagnostic ECG in emergency department. Int J Cardiovasc Imaging 2019 May;35(5):965-71.
6. Heller GV, Stowers SA, Hendel RC, Herman SD, Daher E, Ahlberg AW, et al. Clinical value of acute rest technetium-99m tetrofosmin tomographic myocardial perfusion imaging in patients with acute chest pain and nondiagnostic electrocardiograms. J Am Coll Cardiol 1998 Apr;31(5):1011-7.
7. Nanasato M, Morita S, Yoshida R, Niimi T, Sugimoto M, Tsukamoto K, et al. Detection of coronary artery disease using automated quantitation of myocardial perfusion on single-photon emission computed tomography images from patients with angina pectoris without prior myocardial infarction. Circ J 2012;76(9):2280-2. 
8. Peix A, Batista E, Cabrera LO, Rodríguez L, Padrón K, Saínz B, et al. Gated-SPECT myocardial perfusion imaging and coronary calcium score for evaluation of patients with acute chest pain and a normal or nondiagnostic electrocardiogram. Coron Artery Dis 2012 Nov;23(7):438-44.
9. Stowers SA, Eisenstein EL, Th Wackers FJ, Berman DS, Blackshear JL, Jones AD Jr, et al. An economic analysis of an aggressive diagnostic strategy with single photon emission computed tomography myocardial perfusion imaging and early exercise stress testing in emergency department patients who present with chest pain but nondiagnostic electrocardiograms: results from a randomized trial. Ann Emerg Med 2000 Jan;35(1):17-25.
10. Kontos MC, Schmidt KL, McCue M, Rossiter LF, Jurgensen M, Nicholson CS, et al. A comprehensive strategy for the evaluation and triage of the chest pain patient: a cost comparison study. J Nucl Cardiol 2003 May-Jun;10(3):284-90.
11. Udelson JE, Beshansky JR, Ballin DS, Feldman JA, Griffith JL, Handler J, , et al. Myocardial perfusion imaging for evaluation and triage of patients with suspected acute cardiac ischemia: a randomized controlled trial.  JAMA 2002;288(21):2693-700.
12. Conti A, Gallini C, Costanzo E, Ferri P, Matteini M, Paladini B, et al. Early detection of myocardial ischaemia in the emergency department by rest or exercise 99m Tc tracer myocardial SPET in patients with chest pain and non-diagnostic ECG. Eur J Nucl Med 2001 Dec;28(12):1806-10.
13. Duca MD, Giri S, Wu AH, Morris RS, Cyr GM, Ahlberg A, et al. Comparison of acute rest myocardial perfusion imaging and serum markers of myocardial injury in patients with chest pain syndromes. J Nucl Cardiol 1999 Nov-Dec;6(6):570-6.
14. Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol 2003 Oct 1;42(7):1318-33.
15. Better N, Karthikeyan G, Vitola J, Fatima A, Peix A, Novak MD, et al. Performance of rest myocardial perfusion imaging in the management of acute chest pain in the emergency room in developing nations (PREMIER trial). J Nucl Cardiol 2012;19(6):1146-53.
16. Abbott BG, Jain D. Nuclear cardiology in the evaluation of acute chest pain in the emergency department. Echocardiography 2000;17(6):597-604.