Diagnostic value of left ventricular function after stress and at rest in the detection of multivessel coronary artery disease as assessed by electrocardiogram-gated SPECT
✍ Scribed by Satoshi Hida; Taishiro Chikamori; Hirokazu Tanaka; Yasuhiro Usui; Yuko Igarashi; Tadashi Nagao; Akira Yamashina
- Publisher
- Springer
- Year
- 2007
- Tongue
- English
- Weight
- 293 KB
- Volume
- 14
- Category
- Article
- ISSN
- 1071-3581
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✦ Synopsis
Background:
Although transient left ventricular (lv) dilation is a well-known marker for extensive coronary artery disease (cad), few studies have performed quantitative analysis of lv function after stress and at rest to detect extensive cad.
Methods and results:
Poststress and resting gated single photon emission computed tomography (spect) was performed in 175 patients with suspected cad. all of the patients underwent coronary angiography within 3 months of gated spect. in the 83 patients with multivessel cad, the summed difference score was greater (9.2 +/- 7.0 vs 3.3 +/- 4.0, p < .0001), the poststress increase in end-systolic volume (esv) was larger (7.0 +/- 8.0 ml vs -0.8 +/- 4.7 ml, p < .0001), and the poststress increase in ejection fraction (ef) was less (-4.7% +/- 5.4% vs -0.4% +/- 4.5%, p < .0001) than in the 92 patients with insignificant or single-vessel cad. in the detection of multivessel cad, a summed difference score of 9 or greater showed a sensitivity of 46% and specificity of 90%, whereas an increase in esv of 5 ml or greater and a decrease in ef of 5% or greater after exercise had a sensitivity of 66% and 52%, respectively, and specificity of 87% and 83%, respectively. the multivariate discriminant analysis revealed that the combination of poststress increase in esv, summed difference score, and diabetes mellitus best identified multivessel cad, with a sensitivity of 72% and specificity of 84% (chi(2), 81.7).
Conclusions:
The addition of poststress and at-rest lv functional analysis by use of gated spect to conventional perfusion analysis helps to better identify patients with multivessel cad.