Details

Autor(en) / Beteiligte

• Feola, M.
• Biggi, A.
• Ribichini, F.
• Ferrero, V.
• Racca, E.
• Camuzzini, G.F.
• Uslenghi, E.

Titel

D002: Coronary artery disease in hypertensive patients with heart failure and left bundle branch block: Diagnostic utility of adenosine TC99 tetrofosmin SPECT

Ist Teil von

• American journal of hypertension, 2000-04, Vol.13 (S2), p.158A-158A

Ort / Verlag

Oxford: Oxford University Press

Erscheinungsjahr

2000

Link zum Volltext

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• The purpose of the study was to assess the usefulness of single photon computed tomography (SPECT) with adenosine in the diagnosis of coronary artery disease (CAD) in patients (pts) with hypertension, heart failure and left bundle branch block (LBBB). Twenty consecutive hypertensive pts (12 male; age 64 ± 5.4 years) were admitted to our Hospital with chest pain (9 angina and 11 atypical chest pain) and dyspnea (NYHA II–IV). All pts had complete LBBB and no history of previous myocardial infarction. All pts underwent adenosine TC99 tetrofosmin SPECT and coronary angiography. Adenosine was infused at a constant rate of 140 μg/kg body weight per min for 6 min. The results of SPECT were analysed qualitatively and semiquantitatively (dividing the left ventricle into 20 segments, score from 0 = normal to 4 = absence of detectable tracer uptake in one segment). Four (20%) pts were diabetics, 7 (35%) had hyperlipidemia and 9 (45%) were cigarette smokers. The mean ejection fraction was 37.4 ± 7.9%. The qualitative analysis of SPECT showed: 3 (15%) normal scans; 11 (55%) fixed defects (8 in LAD territory, 2 in LAD + RCA and 1 in RCA territory) and 6 (30%) reversible perfusion defects (1 three-vessel distribution, 3 in RCA; 1 in LAD + RCA and 1 in LAD territory). The summed rest score (SRS) and the summed stress score (SSS) were calculated as 11.1 ± 8.5 and 12.7 ± 8.5 (p = 0.5) respectively. Four (20%) pts had critical stenosis (>70% narrowing) at coronary angiography: 2 had three-vessel disease and 2 had single-vessel disease (1 LAD and 1 RCA). The sensitivity of SPECT in these pts was 75% and the specificity 62%. The positive predictive value was 33%, and the negative predictive value was 91%. It is confirmed that fixed perfusion defects in the septal wall do not usually correspond to coronary stenosis of the LAD. The high negative predictive value of SPECT could be useful for the exclusion of CAD in hypertensive pts with heart failure and LBBB.