Document Detail

The diagnosis of coronary artery disease in hypertensive patients with chest pain and complete left bundle branch block: utility of adenosine Tc-99m tetrofosmin SPECT.
MedLine Citation:
PMID:  12072779     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Hypertensive patients with complete left bundle branch block who experience chest pain present special problems in the radionuclide diagnosis of coronary artery disease (CAD). The aim of this study was to assess the utility of Tc-99m tetrofosmin SPECT for the diagnosis of CAD in 35 hypertensive patients with left bundle branch block hospitalized for chest pain. MATERIALS AND METHODS: Images were analyzed semiquantitatively for the presence of both fixed or reversible perfusion defects (method A) or only reversible defects (method B) in the distribution of the left anterior descending artery (LAD) territory. Perfusion defects observed in the territory of any other coronary artery were always considered. Thirty-five patients without infarction underwent adenosine Tc-99m tetrofosmin SPECT, transthoracic echocardiography, and coronary angiography. RESULTS: The mean left ventricular ejection fraction was calculated as 39.9% +/- 11.6%, and the prevalence of CAD was 29%. The sensitivity of SPECT was identical for the two methods at 89%. The specificity increased 19% with method A and 54% with method B. The positive predictive value remained unsatisfactorily low with both methods (27% for method A and 40% for method B), and the negative predictive value improved from 83% with method A to 93% with method B. CONCLUSIONS: Only reversible perfusion defects in the LAD territory should be considered significant for CAD, and these patients should undergo coronary angiography. Reversible or fixed perfusion defects in the left circumflex and right coronary artery territories should be evaluated according to other clinical parameters (global left ventricular ejection fraction, extension of perfusion defects). The highly negative predictive value of adenosine SPECT could help in the exclusion of CAD.
Mauro Feola; Alberto Biggi; Flavio Ribichini; Gianfranco Camuzzini; Eugeno Uslenghi
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Clinical nuclear medicine     Volume:  27     ISSN:  0363-9762     ISO Abbreviation:  Clin Nucl Med     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-06-19     Completed Date:  2002-08-22     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  7611109     Medline TA:  Clin Nucl Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  510-5     Citation Subset:  IM    
Cardiology Department, S. Croce Hospital, Cuneo, Italy.
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MeSH Terms
Adenosine / diagnostic use
Bundle-Branch Block / complications*
Chest Pain / etiology
Coronary Angiography
Coronary Artery Disease / diagnosis,  etiology,  radionuclide imaging*
Heart Septal Defects / complications
Hypertension / complications*
Middle Aged
Organophosphorus Compounds / diagnostic use
Organotechnetium Compounds / diagnostic use
Predictive Value of Tests
Radiopharmaceuticals / diagnostic use
Sensitivity and Specificity
Stress, Physiological / chemically induced
Tomography, Emission-Computed, Single-Photon
Reg. No./Substance:
0/Organophosphorus Compounds; 0/Organotechnetium Compounds; 0/Radiopharmaceuticals; 0/technetium Tc 99m 1,2-bis(bis(2-ethoxyethyl)phosphino)ethane; 58-61-7/Adenosine

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