False positive results in right coronary artery areas of myocardial perfusion spect in patients with left bundle block and left ventricular dilatation
Abstract
SUMMARY
Objective: The aim of this study is to determine the diagnostic value of myocardial perfusion SPECT (MPSPECT) images in patients with complete left bundle branch block (LBBB) and left ventricular (LV) dilatation.
Method: 25 patients (16 female and 9 male whose mean age 68.2 ± 7) with complete LBBB and LVdilatation have been included in this study. 17 patients who have no typical scintigraphic perfusion abnormality have been evaluated as a control group. LV was divided into segments on the apical, mid and basal short-axis images, and visual perfusion scoring was performed on 1248 segments. Perfusion defects were classified as fixed or reversible. All demographic data and the ejection fraction (EF) values of patients were expressed as average standard deviation. The relation between myocardial perfusion and coronary angiography (CAG) results were evaluated.
Results: In 25 patients who had coronary angiography, the positive diagnostic value of
MPSPECT for left anterior descending coronary artery (LAD) stenosis was 36%, for left circumflex coronary artery (LCx) stenosis was 43%, and for right coronary artery (RCA) stenosis was 16%. Specificity values were 36%, 82% and 13% respectively.
Conclusion: Pharmacologic stress-rest MPSPECT imaging with dipyridamole in the same day increases diagnostic accuracy for detection of coronary artery disease (CAD) in patients with LBBB and LV dilatation. It should be considered that false positive ischemic results detected in RCA areas except for LAD areas in these patients also.
Keywords: Left bundle branch block, Left ventricular dilatation, T1-201, Tc-99m, MIBI, SPECT, dipyridamole
ÖZET
Amaç: Bu çalışmanın amacı komplet sol dal bloğu (LBBB) ve sol ventrikül (LV) dilatasyonu bulunan hastalarda miyokart perfüzyon SPECT (MPSPECT) görüntülemenin tanısal değerini belirlemektir.
Yöntem: LV dilatasyonu ve LBBB bulunan 25 hasta (16 kadın, 9 erkek, yaş ortalaması: 68,2 ± 7 yıl) incelendi. Kontrol grubu olarak tipik sintigrafik perfüzyon anomalisi saptanmayan 17 hasta alınmıştır. Apikal, orta ve bazal kısa eksen görüntüleri üzerinde LV segmentlere ayrıldı ve 1248 segmentte vizüel perfüzyon skorlaması yapıldı. Perfüzyon defektleri sabit veya reversibl olarak sınıflandırıldı. Hastaların tüm demografik verileri ile EF değerleri ortalama±standart sapma olarak ifade edildi. Perfüzyon değişiklikleri ile koroner anjiografi (KAG) sonuçları arasındaki ilişki değerlendirildi.
Bulgular: Koroner anjiografileri yapılan 25 hastada MPSPECT’in pozitif tanı değeri; sol ön inen koroner arter (LAD) stenozu için %36, sol sirkümfleks arter (LCx) stenozu için %43 ve sağ koroner arter (RCA) stenozu için %16 idi. Spesifisite değerleri sırasıyla %36, %82 ve %13 idi.
Sonuç: Bu hastalarda LAD alanı haricinde RCA alanında da yanlış pozitif iskemi saptanabileceği göz önünde bulundurulmalıdır. Ayrıca LBBB ve LV dilatasyonu bulunan hastalarda koroner arter hastalığının (KAH) saptanmasında dipiridamol ile farmakolojik stres testinin, istirahat-stres Tc-99m MIBI MPSPECT görüntüleme protokolü ile aynı gün uygulanması tanısal doğruluğu arttırmaktadır.
Anahtar sözcükler: Sol dal bloğu, sol ventrikül dilatasyonu, Tl-201, Tc-99m MİBİ, spect, dipiridamol
References
- Jeong JH, Kim JH, Park YH, Han DC, Hwang KW, Lee DW, Oh JH, Song SG, Kim JS, Chun KJ, Hong TJ, Shin YW. Incidence of and risk faktors for bundle branch block in adults older than 40 years. Korean J Intern Med. 2004; 19: 171-8.
- Lewis CM, Dagenais GR, Frie- singer GC, Ross RS. Coronary ar- teriographic appearances in pa- tients with left bundle branch block. Circulation 1970; 41: 299- 307.
- Beller GA, Zaret BL. Contribu- tions of nuclear cardiology to di- agnosis and prognosis of patients with coronary artery disease. Cir- culation 2000; 101:1465-78.
- Alexanderson E, Mannting F, Gomez-Martın D, Fermona S, Meaveb
- Sestamibi SPECT Myocardial Per- fusion Imaging in Patients with Complete Left Bundle Branch. Ar- chives of Medical Research 2004; 35: 150-6.
- Brodov Y, Guetta V, Di Segni E, Chouraqui P.J. Clinical predictors of stress-induced transient left ven- tricular dilatation in patients with nonsignificant coronary disease. Clin Hypertens 2010; 12: 693-7.
- Haji SA, Ulusoy RE, Patel DA, Srinivasan SR, Chen W, Delafon- taine P, Berenson GS. Predictors of left ventricular dilatation in young adults (from the Bogalusa Heart Study). Am J Cardiol 2006; 98: 1234-7.
- Ravizzini GC, Hanson MW, Shaw LK, Wong TZ, Hagge RJ, Pagnan- elli RA, Jain D, Lima HS, Cole- man RE, Bornes-Neto S. Efficien- cy Comparison between 99mTc- tetrofosmin and 99mTc-sestamibi Myocardial Perfusion Studies. Nu- clear Medicine Communications 2002; 23: 203-8.
- Turgut B, Unlü M, Cengel A. Do- Stress butamine
- SPECT; Evaluation of Short Rest- Stress Protocol and Head to Head Comparison with MIBI in Detec- tion of Coronary Artery Disease. Annals of Nuclear Medicine 2005; 19: 115-22.
- De Sutter J, Van de Wiele C, D'Asseler Y, De Bondt P, De Backer G, Rigo P, Dierckx R. Au- tomatic quantification of defect size using normal templates: a comparative clinical study of three commercially
- rithms. Eur J Nucl Med. 2000; 27: 1827-34.
- algo- 10. Hasbek Z, Turgut B, Erselcan T, Yalta K, Tandogan I, Ozer G, Ozdemir U, Turgut NH. Evalua- tion of myocardial viability with thallium-201 infusion MPSPECT after oral glucose application in patients with chronic coronary ar- tery disease. Nuclear Medicine Communications. 2009; 30: 779- 88.
- Mahrholdt H, Zhydkov A, Hager S, Meinhardt G, Vogelsberg H, Wagner A, Sechtem U. Left ven- tricular wall motion abnormalities as well as reduced wall thickness can cause false positive results of routine SPECT perfusion imaging for detection of myocardial infarc- tion. European Heart Journal 2005; 26: 2127-35.
- Knapp WH, Bentrup A, Schmidt U, Ohlmeier H. Myocardial scin- tigraphy with thallium-201 and technetium-99m-hexakis methoxy- isobutylisonitrile in left bundle branch block: a study in patients with and without coronary artery disease. Eur J Nucl Med 1993; 20: 219-24.
- Zammarchi A, Pitscheider W, Crepaz R, Oberhollenzer R, Erli- cher A, Unterhuber E, Osele L, Braito E. Exercise 201-thallium myocardial scintigraphy in left bundle branch block G Ital Cardiol 1994; 24: 1103-13.
- Higgins JP, Williams G, Nagel JS, Higgins JA. Left bundle-branch block artifact on single photon emission computed tomography with technetium Tc 99m (Tc-99m) agents: Mechanisms and a method to decrease false-positive interpre- tations. Am Heart J 2006; 152: 619-26.
- Ellmann A, Heerden PD, Heerden BB, Klopper JF. 99mTc-MIBI stress-rest myocardial perfusion scintigraphy in patients with com- plete left bundle branch block. Cardiovasc J S Afr 2001; 12: 252- 6.
- Richter WS, Aurisch R, Munz DL. Septal myocardial perfusion in complete left bundle branch block: case report and review of the liter- ature 37:146-50.
- 1998; 19. Villanueva FS, Kaul S, Smith WH, Watson DD, Varma SK, Beller GA. Prevalence and correlates of increased lung/heart ratio of thalli- um-201 during dipyridamole stress imaging for suspected coronary ar- tery disease. The American Jour- nal of Cardiology 1990; 66:1324- 8.
- Goland S, Shimoni S, Livschitz S, Loutaty G, Azulay O, Levy R, Caspi A, Arditi A. Dipyridamole- induced abnormal Tl-201 lung up- take in patients with normal myo- cardial perfusion: a marker of in- creased left ventricular filling pressures. J Nucl Cardiol 2004; 11: 305-11.
- Feola M, Biggi A, Ribichi F, Ca- muzzini G, Uslenghi E. The Diag- nosis of Coronary Artery Disease in Hypertensive Patients with Chest Pain and Complete Left Bundle Branch Block Utility of Adenosine Tc-99m Tetrofosmin SPECT Clin Nucl Med 2002; 27: 510-5.
- Möller J, Warwick J, Bouma H. Myocardial perfusion scintigraphy with Tc-99m MIBI in patients with left bundle branch block: Visual quantification of the anteroseptal perfusion imaging for the diagno- sis of left anterior descending ar- tery stenosis. Cardiovasc J S Afr 2005; 16: 95-101.
Sol dal bloğu ve sol ventrikül dilatasyonu olan hastalarda “miyokart perfüzyon spect” in sağ koroner arter alanlarındaki yanlış pozitif sonuçları
Abstract
Amaç: Bu çalışmanın amacı komplet sol dal bloğu (LBBB) ve sol ventrikül (LV) dilatasyonu bulunan hastalarda miyokart perfüzyon SPECT (MPSPECT) görüntülemenin tanısal değerini belirlemektir. Yöntem: LV dilatasyonu ve LBBB bulunan 25 hasta (16 kadın, 9 erkek, yaş ortalaması: 68,2 ± 7 yıl) incelendi. Kontrol grubu olarak tipik sintigrafik perfüzyon anomalisi saptanmayan 17 hasta alınmıştır. Apikal, orta ve bazal kısa eksen görüntüleri üzerinde LV segmentlere ayrıldı ve 1248 segmentte vizüel perfüzyon skorlaması yapıldı. Perfüzyon defektleri sabit veya reversibl olarak sınıflandırıldı. Hastaların tüm demografik verileri ile EF değerleri ortalama±standart sapma olarak ifade edildi. Perfüzyon değişiklikleri ile koroner anjiografi (KAG) sonuçları arasındaki ilişki değerlendirildi. Bulgular: Koroner anjiografileri yapılan 25 hastada MPSPECT’in pozitif tanı değeri; sol ön inen koroner arter (LAD) stenozu için %36, sol sirkümfleks arter (LCx) stenozu için %43 ve sağ koroner arter (RCA) stenozu için %16 idi. Spesifisite değerleri sırasıyla %36, %82 ve %13 idi. Sonuç: Bu hastalarda LAD alanı haricinde RCA alanında da yanlış pozitif iskemi saptanabileceği göz önünde bulundurulmalıdır. Ayrıca LBBB ve LV dilatasyonu bulunan hastalarda koroner arter hastalığının (KAH) saptanmasında dipiridamol ile farmakolojik stres testinin, istirahat-stres Tc99m MIBI MPSPECT görüntüleme protokolü ile aynı gün uygulanması tanısal doğruluğu arttırmaktadır
References
- Jeong JH, Kim JH, Park YH, Han DC, Hwang KW, Lee DW, Oh JH, Song SG, Kim JS, Chun KJ, Hong TJ, Shin YW. Incidence of and risk faktors for bundle branch block in adults older than 40 years. Korean J Intern Med. 2004; 19: 171-8.
- Lewis CM, Dagenais GR, Frie- singer GC, Ross RS. Coronary ar- teriographic appearances in pa- tients with left bundle branch block. Circulation 1970; 41: 299- 307.
- Beller GA, Zaret BL. Contribu- tions of nuclear cardiology to di- agnosis and prognosis of patients with coronary artery disease. Cir- culation 2000; 101:1465-78.
- Alexanderson E, Mannting F, Gomez-Martın D, Fermona S, Meaveb
- Sestamibi SPECT Myocardial Per- fusion Imaging in Patients with Complete Left Bundle Branch. Ar- chives of Medical Research 2004; 35: 150-6.
- Brodov Y, Guetta V, Di Segni E, Chouraqui P.J. Clinical predictors of stress-induced transient left ven- tricular dilatation in patients with nonsignificant coronary disease. Clin Hypertens 2010; 12: 693-7.
- Haji SA, Ulusoy RE, Patel DA, Srinivasan SR, Chen W, Delafon- taine P, Berenson GS. Predictors of left ventricular dilatation in young adults (from the Bogalusa Heart Study). Am J Cardiol 2006; 98: 1234-7.
- Ravizzini GC, Hanson MW, Shaw LK, Wong TZ, Hagge RJ, Pagnan- elli RA, Jain D, Lima HS, Cole- man RE, Bornes-Neto S. Efficien- cy Comparison between 99mTc- tetrofosmin and 99mTc-sestamibi Myocardial Perfusion Studies. Nu- clear Medicine Communications 2002; 23: 203-8.
- Turgut B, Unlü M, Cengel A. Do- Stress butamine
- SPECT; Evaluation of Short Rest- Stress Protocol and Head to Head Comparison with MIBI in Detec- tion of Coronary Artery Disease. Annals of Nuclear Medicine 2005; 19: 115-22.
- De Sutter J, Van de Wiele C, D'Asseler Y, De Bondt P, De Backer G, Rigo P, Dierckx R. Au- tomatic quantification of defect size using normal templates: a comparative clinical study of three commercially
- rithms. Eur J Nucl Med. 2000; 27: 1827-34.
- algo- 10. Hasbek Z, Turgut B, Erselcan T, Yalta K, Tandogan I, Ozer G, Ozdemir U, Turgut NH. Evalua- tion of myocardial viability with thallium-201 infusion MPSPECT after oral glucose application in patients with chronic coronary ar- tery disease. Nuclear Medicine Communications. 2009; 30: 779- 88.
- Mahrholdt H, Zhydkov A, Hager S, Meinhardt G, Vogelsberg H, Wagner A, Sechtem U. Left ven- tricular wall motion abnormalities as well as reduced wall thickness can cause false positive results of routine SPECT perfusion imaging for detection of myocardial infarc- tion. European Heart Journal 2005; 26: 2127-35.
- Knapp WH, Bentrup A, Schmidt U, Ohlmeier H. Myocardial scin- tigraphy with thallium-201 and technetium-99m-hexakis methoxy- isobutylisonitrile in left bundle branch block: a study in patients with and without coronary artery disease. Eur J Nucl Med 1993; 20: 219-24.
- Zammarchi A, Pitscheider W, Crepaz R, Oberhollenzer R, Erli- cher A, Unterhuber E, Osele L, Braito E. Exercise 201-thallium myocardial scintigraphy in left bundle branch block G Ital Cardiol 1994; 24: 1103-13.
- Higgins JP, Williams G, Nagel JS, Higgins JA. Left bundle-branch block artifact on single photon emission computed tomography with technetium Tc 99m (Tc-99m) agents: Mechanisms and a method to decrease false-positive interpre- tations. Am Heart J 2006; 152: 619-26.
- Ellmann A, Heerden PD, Heerden BB, Klopper JF. 99mTc-MIBI stress-rest myocardial perfusion scintigraphy in patients with com- plete left bundle branch block. Cardiovasc J S Afr 2001; 12: 252- 6.
- Richter WS, Aurisch R, Munz DL. Septal myocardial perfusion in complete left bundle branch block: case report and review of the liter- ature 37:146-50.
- 1998; 19. Villanueva FS, Kaul S, Smith WH, Watson DD, Varma SK, Beller GA. Prevalence and correlates of increased lung/heart ratio of thalli- um-201 during dipyridamole stress imaging for suspected coronary ar- tery disease. The American Jour- nal of Cardiology 1990; 66:1324- 8.
- Goland S, Shimoni S, Livschitz S, Loutaty G, Azulay O, Levy R, Caspi A, Arditi A. Dipyridamole- induced abnormal Tl-201 lung up- take in patients with normal myo- cardial perfusion: a marker of in- creased left ventricular filling pressures. J Nucl Cardiol 2004; 11: 305-11.
- Feola M, Biggi A, Ribichi F, Ca- muzzini G, Uslenghi E. The Diag- nosis of Coronary Artery Disease in Hypertensive Patients with Chest Pain and Complete Left Bundle Branch Block Utility of Adenosine Tc-99m Tetrofosmin SPECT Clin Nucl Med 2002; 27: 510-5.
- Möller J, Warwick J, Bouma H. Myocardial perfusion scintigraphy with Tc-99m MIBI in patients with left bundle branch block: Visual quantification of the anteroseptal perfusion imaging for the diagno- sis of left anterior descending ar- tery stenosis. Cardiovasc J S Afr 2005; 16: 95-101.
Details
| Primary Language | English |
|---|---|
| Journal Section | Medical Science Research Articles |
| Authors | |
| Publication Date | February 26, 2015 |
| Published in Issue | Year 2015Volume: 37 Issue: 3 |