Assessment of Cases with Intermediate Coronary Artery Stenosis Using Instantaneous Wave Free Ratio Versus Myocardial Perfusion Imaging by Single Photon Emission Tomography

Document Type : Original Article

Authors

1 Master degree of cardiology

2 Professor of Cardiovascular medicine Faculty of Medicine - Benha University

3 Assistant Professor of Cardiology, Faculty of Medicine, Benha University

4 Assistant Professor of Cardiovascular Medicine Faculty of Medicine - Benha University

10.21608/bmfj.2025.383668.2404

Abstract

Background: Coronary artery disease (CAD) continues to be a major global health burden. Accurately evaluating coronary severity is essential for deciding whether revascularization is necessary. Intermediate coronary artery stenosis presents a diagnostic challenge; as anatomical severity does not always correlate with functional significance. This study aimed to use myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) with the instantaneous wave-free ratio (iFR) for assessing the functional relevance of intermediate coronary lesions. Methods: This was a prospective observational study included 50 cases diagnosed with intermediate coronary disease. It was conducted in the National Heart Institute in Cairo, and Benha University Hospitals, Egypt, during the period from January 2022 to Mars 2024. Results: MPI results in 22 of the participants, or 44%, have positive myocardial perfusion defects. The majority, comprising 28 participants or 56%, showed negative MPI results. Also, the IFR has a mean value of 0.90 with a standard deviation of 0.03 with values spanning from 0.84 to 0.96. Regarding the agreement between MPI and IFR tests, a kappa value of 0.878, with a p-value of less than 0.001, indicates a very strong agreement between these two diagnostic methods. Specifically, 20 cases (40%) were positively identified by both MPI and IFR, while 27 cases (54%) were negative in both tests, underscoring a high level of consistency. Conclusion: The SPECT, with its high level of diagnostic agreement with iFR, is considered a reliable, non-invasive alternative that avoids the complexities and risks associated with invasive intervention and radiation exposure

Keywords

Benha Medical Journal
Volume 42, Issue 11
(annual conference issue II)
November 2025
Pages 83-93

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