Introduction/Aim. Anatomically insignificant stenosis of coronary arteries obtained on coronary angiography, in numerous cases can show hemodynamic significance and as such cause ischemic myocardial changes. The goal was to assess the diagnostic accuracy of myocardial perfusion scintigraphy (SPECT MPI) in the detection of hemodinamically significant coronary artery stenosis in patients with moderate risk for ischemia, without previously detected coronary disease. Patients and methodology. The study included 258 patients, of which 54% females and 46% males, with an average age of 59.0 ± 10.1 years. SPECT MPI was done by a two-day protocol with 99 mTc-MIBI. The pathological finding was the existence of perfusion defects. The physical stress test was done by Bruce protocol. Coronary angiography (CA) was performed according to a standard protocol in patients with pathological SPECT MPI findings (n = 128). Anatomically significant coronary artery narrowing was > 70%. Stenoses from 30% to 69% were considered hemodynamically significant in patients with reversible perfusion defects on SPECT MPI. Results. The sensitivity (SE) of SPECT MPI was 89%, specificity (SP) 42%, positive predictive value (PPV) 86%, negative predictive value (NPV) 50%, and total diagnostic accuracy (ACC) was 74% when the results were compared with stenosis > 70%. By including stenosis from 30% to 69%, the obtained values of diagnostic indicators of SPECT MPI reliability were: SE 91%; SP 100%; PPV 100%; NPV 50% and ACC 91%. Conclusion. With CA only, it is not possible to prove the existence of hemodynamic significance of coronary artery stenoses from 30% to 69%, which represents a recruitment range for developing ischemia. SPECT MPI shows high SE, SP, PPV, and ACC in detecting the existence of left ventricular myocardium perfusion disorder in either stenosis of coronary arteries with or without anatomically significant value.
References
1.
Fleischmann KE, Hunink MGM, Kuntz KM, Douglas PS. Exercise Echocardiography or Exercise SPECT Imaging? JAMA. 1998;280(10):913.
2.
Unal B, Critchley JA, Capewell S. Explaining the Decline in Coronary Heart Disease Mortality in England and Wales Between 1981 and 2000. Circulation. 2004;109(9):1101–7.
3.
2013 ESC guidelines on the management of stable coronary artery disease. European Heart Journal. 2013;34(38):2949–3003.
4.
Nakanishi R, Rana JS, Rozanski A, Cheng VY, Gransar H, Thomson LEJ, et al. Relationship of dyspnea vs. typical angina to coronary artery disease severity, burden, composition and location on coronary CT angiography. Atherosclerosis. 2013;230(1):61–6.
5.
Diamond GA, Forrester JS. Analysis of Probability as an Aid in the Clinical Diagnosis of Coronary-Artery Disease. New England Journal of Medicine. 1979;300(24):1350–8.
6.
Pepine CJ, Balaban RS, Bonow RO, Diamond GA, Johnson BD, Johnson PA, et al. Women’s Ischemic Syndrome Evaluation. Circulation. 2004;109(6).
COHEN A, ZANNAD F, KAYANAKIS JG, GUERET P, AUPETIT JF, KOLSKY H, et al. Multicentre study of the determination of peak oxygen uptake and ventilatory threshold during bicycle exercise in chronic heart failure. European Heart Journal. 1991;12(10):1055–63.
9.
Douglas PS. Is Noninvasive Testing for Coronary Artery Disease Accurate? Circulation. 1997;95(2):299–302.
10.
Shaw LJ, Hachamovitch R, Peterson ED, Lewin HC, Iskandrian AE, Miller DD, et al. Using an outcomes-based approach to identify candidates for risk stratification after exercise treadmill testing. Journal of General Internal Medicine. 1999;14(1):1–9.
11.
Samler J. A Series on In‐Service Training. The Personnel and Guidance Journal. 1957;35(5):315–315.
12.
Melin JA, Wijns W, Vanbutsele RJ, Robert A, De Coster P, Brasseur LA, et al. Alternative diagnostic strategies for coronary artery disease in women: demonstration of the usefulness and efficiency of probability analysis. Circulation. 1985;71(3):535–42.
Stramba-Badiale M, Bonazzi O, Casadei G, Palù CD, Magnani B, Zanchetti A. Prevalence of episodes of ST-segment depression among mild-to-moderate hypertensive patients in northern Italy. Journal of Hypertension. 1998;16(5):681–8.
15.
Leape LL, Park RE, Bashore TM, Harrison JK, Davidson CJ, Brook RH. Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularization procedures. American Heart Journal. 2000;139(1):106–13.
16.
Nakazato R, Shalev A, Doh JH, Koo BK, Gransar H, Gomez MJ, et al. Aggregate Plaque Volume by Coronary Computed Tomography Angiography Is Superior and Incremental to Luminal Narrowing for Diagnosis of Ischemic Lesions of Intermediate Stenosis Severity. Journal of the American College of Cardiology. 2013;62(5):460–7.
17.
Ambrose JA, Tannenbaum MA, Alexopoulos D, Hjemdahl-Monsen CE, Leavy J, Weiss M, et al. Angiographic progression of coronary artery disease and the development of myocardial infarction. Journal of the American College of Cardiology. 1988;12(1):56–62.
18.
Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, et al. Low Diagnostic Yield of Elective Coronary Angiography. New England Journal of Medicine. 2010;362(10):886–95.
19.
Bruce RA, Lovejoy FW, Pearson R, Yu PNG, Brothers GB, Velasquez T. NORMAL RESPIRATORY AND CIRCULATORY PATHWAYS OF ADAPTATION IN EXERCISE 1. Journal of Clinical Investigation. 1949;28(6 Pt 2):1423–30.
20.
Crossman DC. The pathophysiology of myocardial ischaemia. Heart. 2004;90(5):576–80.
21.
Dangas G, Mintz GS, Mehran R, Lansky AJ, Kornowski R, Pichard AD, et al. Preintervention Arterial Remodeling as an Independent Predictor of Target-Lesion Revascularization After Nonstent Coronary Intervention. Circulation. 1999;99(24):3149–54.
22.
Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, et al. ACC/AHA guidelines for coronary angiography11“ACC/AHA Guidelines for Coronary Angiography” was approved by the American College of Cardiology Board of Trustees in October 1998 and by the American Heart Association Science Advisory and Coordinating Committee in December 1998.22When citing this document, the American College of Cardiology and the American Heart Association request that the following format be used: Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, Legako RD, Leon DF, Murray JA, Nissen SD, Pepine CJ, Watson RM. ACC/AHA guidelines for coronary angiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography). J Am Coll Cardiol1999;33:1756–82433This document is available on the websites of the ACC (www.acc.org) and the AHA (www.americanheart.org). Reprints of this document (the complete guidelines) are available for $5 each by calling 800-253-4636 (US only) or writing the American College of Cardiology, Educational Services, 9111 Old Georgetown Road, Bethesda, MD 20814-1699. Ask for reprint No. 71-0164. To obtain a reprint of the shorter version (executive summary and summary of recommendations) published in the May 4, 1999, issue of Circulation, ask for reprint No. 71-0163. To purchase additional reprints (specify version and reprint number): up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342, or e-mail pubauth@heart.org. Journal of the American College of Cardiology. 1999;33(6):1756–824.
23.
Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction—summary article. Journal of the American College of Cardiology. 2002;40(7):1366–74.
24.
Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. Journal of the American College of Cardiology. 2012;60(24):e44–164.
25.
Hesse B, Tägil K, Cuocolo A, Anagnostopoulos C, Bardiés M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. European Journal of Nuclear Medicine and Molecular Imaging. 2005;32(7):855–97.
26.
KULA M, TUTU?? A, ??NAL ??, TOPSAKAL R, ERGIN A. Technetium-99m-tetrofosmin imaging with incremental nitroglycerin infusion to detect severely ischaemic but viable myocardium: a comparative study with thallium-201??? Nuclear Medicine Communications. 2003;24(9):987–94.
27.
Niyaz K, Niaz K, Zaman MU. Assessment of viable myocardium by nitrate augmented 99mTc MIBI myocardial perfusion imaging. J Pak Med Assoc. 2007;57:83–7.
28.
Hung MJ, Hu P, Hung MY. Coronary Artery Spasm: Review and Update. International Journal of Medical Sciences. 2014;11(11):1161–71.
29.
Bruce RA, Pearson R, Lovejoy FW, Yu PNG, Brothers GB. VARIABILITY OF RESPIRATORY AND CIRCULATORY PERFORMANCE DURING STANDARDIZED EXERCISE 1. Journal of Clinical Investigation. 1949;28(6 Pt 2):1431–8.
30.
Quantitative exercise testing for the cardiac patient: the value of monitoring gas exchange: introduction. Circulation. 1987;76:1–58.
31.
Londeree BR, Moeschberger ML. Influence of age and other factors on maximal heart rate. J Cardiac Rehabil. 1984;4:44–9.
32.
Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. Journal of the American College of Cardiology. 2001;37(1):153–6.
33.
SPELLBERG RD, UNGAR I. The Percutaneous Femoral Artery Approach to Selective Coronary Arteriography. Circulation. 1967;36(5):730–3.
34.
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Journal of the American College of Cardiology. 2011;58(24):e44–122.
35.
Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, et al. ACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Imaging—Executive Summary. Circulation. 2003;108(11):1404–18.
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