Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block
| Autor: | Cesar Higa Nomura, Carlos E. Rochitte, Luiz Francisco Rodrigues de Ávila, Estêvan Vieira Cabeda, Andréa Maria Gomes Falcão, José R. Parga, José Soares |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty lcsh:Diseases of the circulatory (Cardiovascular) system Time Factors Vasodilator Agents Bundle-Branch Block Imagem de Perfusão Miocárdica Coronary Artery Disease Bloqueio de Ramo Single-photon emission computed tomography Coronary Angiography Dipiridamol Sensitivity and Specificity Coronary artery disease Myocardial perfusion imaging Risk Factors Angiografia Coronária Multidetector Computed Tomography medicine Humans Prospective Studies Aged Tomography Emission-Computed Single-Photon medicine.diagnostic_test Bundle branch block business.industry Left bundle branch block Myocardial Perfusion Imaging Reproducibility of Results Original Articles Dipyridamole Middle Aged Radiation Exposure medicine.disease Stenosis lcsh:RC666-701 Female Radiology Tomografia Computadorizada por Multidetectores Cardiology and Cardiovascular Medicine business Nuclear medicine Perfusion medicine.drug Doença Arterial Coronariana |
| Zdroj: | Arquivos Brasileiros de Cardiologia, Iss 0, Pp 0-0 (2015) Arquivos Brasileiros de Cardiologia, Volume: 105, Issue: 6, Pages: 614-624, Published: 25 SEP 2015 Arquivos Brasileiros de Cardiologia Arquivos Brasileiros de Cardiologia v.105 n.6 2015 Sociedade Brasileira de Cardiologia (SBC) instacron:SBC |
| ISSN: | 1678-4170 |
| Popis: | Background: Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB). Objective: To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA) and compare the results with those of single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy. Methods: Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution’s ethics committee. Results: The patients’ mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001). The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001). In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001). Conclusion: The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB. Resumo Fundamentos: Testes funcionais possuem limitada acurácia para identificar isquemia miocárdica em pacientes com bloqueio de ramo esquerdo (BRE). Objetivo: Utilizando tomógrafo com 320 detectores foi avaliado a acurácia diagnóstica da perfusão miocárdica de estresse com dipiridamol pela tomografia (PMT) em pacientes com BRE utilizando a angiografia coronária quantitativa invasiva (QCA) (estenose ≥ 70%) como referência. Procurou-se também investigar o valor adicional da PMT sobre a angiotomografia coronariana (ATC) comparando a acurácia com a cintilografia perfusional miocárdica (SPECT). Métodos: Trinta pacientes com BRE e SPECT prévio em investigação de doença arterial coronariana foram encaminhados para realização do protocolo de estresse na tomografia. Observadores independentes realizaram avaliação por paciente e por território coronariano. Todos os pacientes assinaram um termo de consentimento livre e esclarecido aprovado pelo Comitê de Ética da Instituição. Resultados: A média de idade foi 62 ± 10 anos. A dose média de radiação do protocolo de tomografia foi 9,3 ± 4,6 mSv. Em relação a PMT, na análise por paciente, a sensibilidade, especificidade, valores preditivos positivos e negativos e acurácia foram, respectivamente, 86%, 81%, 80%, 87%, 83% p = 0,001. Na análise por território os valores foram, respectivamente, 63%, 86% a 65%, 84%, 79% p < 0,001. Em ambas as análises, a adição da PMT a ATC determinou maior acurácia diagnóstica para detecção de isquemia miocárdica quando comparado com o SPECT (p < 0,001). Conclusão: O uso do protocolo de estresse na tomografia é viável e tem boa acurácia diagnóstica na pesquisa de isquemia miocárdica nos pacientes com BRE. |
| Databáze: | OpenAIRE |
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