1. Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block.
- Author
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Cabeda EV, Falcão AM, Soares J Jr, Rochitte CE, Nomura CH, Ávila LF, and Parga JR
- Subjects
- Aged, Coronary Angiography methods, Female, Humans, Male, Middle Aged, Multidetector Computed Tomography instrumentation, Prospective Studies, Radiation Exposure, Reproducibility of Results, Risk Factors, Sensitivity and Specificity, Time Factors, Bundle-Branch Block diagnostic imaging, Coronary Artery Disease diagnostic imaging, Dipyridamole, Myocardial Perfusion Imaging methods, Tomography, Emission-Computed, Single-Photon methods, Vasodilator Agents
- Abstract
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.
- Published
- 2015
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