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Comparative utility of gated myocardial perfusion imaging and transthoracic coronary flow reserve for the assessment of coronary artery disease in patients with left bundle branch block

Smiljana PavlovićInstitute of Nuclear Medicine, Belgrade, SerbiaDragana Šobić-ŠaranovićInstitute of Nuclear MedicineAna Djordjevic‐DikicInstitute for Cardiovascular Diseases, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, SerbiaBranko BeleslinInstitute for Cardiovascular Diseases, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, SerbiaJelena StepanovićInstitute for Cardiovascular Diseases, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, SerbiaVera ArtikoInstitute of Nuclear MedicineVojislav GigaInstitute for Cardiovascular Diseases, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, SerbiaZorica PetrasinovicInstitute for Cardiovascular Diseases, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, SerbiaMiodrag OstojićInstitute for Cardiovascular Diseases, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, SerbiaBosiljka Vujisić-TešićInstitute for Cardiovascular Diseases, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, SerbiaVladimir ObradovićInstitute of Nuclear Medicine

Nuclear Medicine Communicationsjournal2010en

ABI

Annotatsiya

OBJECTIVES: To compare the diagnostic utility of gated single-photon emission computed tomography (SPECT) methoxy isobutyl isonitrile (MIBI) myocardial perfusion imaging and transthoracic Doppler echocardiography (TTDE) coronary flow reserve (CFR) to coronary angiography for detecting coronary artery disease (CAD) in patients with left bundle branch block (LBBB). METHOD: Forty-three patients with complete LBBB and an intermediate pretest probability for CAD underwent dipyridamole stress TTDE and gated SPECT MIBI during the same session and coronary angiography within a month. The parameters of myocardial perfusion (summed stress score, summed difference scores) regional wall function (wall motion score, wall thickening score) and ejection fraction were derived using the 17-segment model and 4D-MSPECT software. TTDE variables included peak flow velocity at rest and during hyperemia in left anterior descending artery (LAD), based on which CFR was calculated (normal>2). RESULTS: Perfusion ischemic scores were significantly higher in group 1 with angiographic evidence of greater than 50% LAD stenosis compared with group 2 with less than 50% LAD stenosis (summed stress score 12.4+/-5.5 vs. 8.3+/-3.5, P<0.05, summed difference score 3.7+/-1.2 vs. 1.1+/-0.3, P<0.01, respectively). Left ventricular regional wall function and ejection fraction were not different between the two groups. CFR was significantly lower in group 1 than in group 2 (1.65+/-0.21 vs. 2.31+/-0.28, P<0.001). Gated SPECT MIBI and CFR had similar sensitivity (88 vs. 88%), specificity (80 vs. 84%), and accuracy (84 vs. 86%) for detecting CAD in patients with LBBB. The agreement between the two methods was 85%. CONCLUSION: Our results show comparable diagnostic utility and high agreement between gated SPECT MIBI perfusion imaging and TTDE CFR assessment for detecting CAD in patients with LBBB. The advantage of gated SPECT MIBI over TTDE CFR measurements is the ability to assess the perfusion abnormalities in multiple vascular territories during the same procedure, which is convenient for detecting multi-vessel disease in patients with LBBB.

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Cardiac Imaging and Diagnostics Coronary Interventions and Diagnostics Cardiovascular Function and Risk Factors

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DOI: 10.1097/mnm.0b013e328335e5f2

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