Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block

作者：Cabeda Estevan Vieira^*; Gomes Falcao Andrea Maria; Soares Jose Jr; Rochitte Carlos Eduardo; Nomura Cesar Higa; Rodrigues Avila Luiz Francisco; Parga Jose Rodrigues

来源：Arquivos Brasileiros de Cardiologia, 2015, 105(6): 614-624.

DOI：10.5935/abc.20150117

• Bundle-Branch Block
• Myocardial Perfusion Imaging
• Multidetector Computed Tomography
• Coronary Angiography
• Dipyridamole
• Coronary Artery Disease

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.

• 出版日期2015-12