Taner ERSELCAN, Zekiye HASBEK, Serdar Savaş GÜL, Bülent TURGUT

False positive results in right coronary artery areas of myocardial perfusion spect in patients with left bundle block and left ventricular dilatation

Amaç: Bu çalışmanın amacı komplet sol dal bloğu (LBBB) ve sol ventrikül (LV) dilatasyonubulunan hastalarda miyokart perfüzyon SPECT (MPSPECT) görüntülemenin tanısal değerinibelirlemektir.Yöntem: LV dilatasyonu ve LBBB bulunan 25 hasta (16 kadın, 9 erkek, yaş ortalaması: 68,2 ±7yıl) incelendi. Kontrol grubu olarak tipik sintigrafik perfüzyon anomalisi saptanmayan 17 hastaalınmıştır. Apikal, orta ve bazal kısa eksen görüntüleri üzerinde LV segmentlere ayrıldı ve 1248segmentte vizüel perfüzyon skorlaması yapıldı. Perfüzyon defektleri sabit veya reversibl olaraksınıflandırıldı. Hastaların tüm demografik verileri ile EF değerleri ortalama±standart sapma olarakifade edildi. Perfüzyon değişiklikleri ile koroner anjiografi (KAG) sonuçları arasındaki ilişkideğerlendirildi.Bulgular: Koroner anjiografileri yapılan 25 hastada MPSPECTin pozitif tanı değeri; sol ön inenkoroner arter (LAD) stenozu için %36, sol sirkümfleks arter (LCx) stenozu için %43 ve sağkoroner 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 saptanabileceğigöz önünde bulundurulmalıdır. Ayrıca LBBB ve LV dilatasyonu bulunan hastalarda koroner arterhastalığının (KAH) saptanmasında dipiridamol ile farmakolojik stres testinin, istirahat-stres Tc- 99m MIBI MPSPECT görüntüleme protokolü ile aynı gün uygulanması tanısal doğruluğuarttırmaktadır.

Sol dal bloğu ve sol ventrikül dilatasyonu olan hastalarda miyokart perfüzyon spectin sağ koroner arter alanlarındaki yanlış pozitif sonuçları

Objective: The aim of this study is to determine the diagnostic value of myocardial perfusionSPECT (MPSPECT) images in patients with complete left bundle branch block (LBBB) and leftventricular (LV) dilatation.Method: 25 patients (16 female and 9 male whose mean age 68.2 ± 7) with complete LBBB andLVdilatation have been included in this study. 17 patients who have no typical scintigraphicperfusion abnormality have been evaluated as a control group. LV was divided into segments onthe apical, mid and basal short-axis images, and visual perfusion scoring was performed on 1248segments. Perfusion defects were classified as fixed or reversible. All demographic data and theejection fraction (EF) values of patients were expressed as average standard deviation. The relationbetween myocardial perfusion and coronary angiography (CAG) results were evaluated.Results: In 25 patients who had coronary angiography, the positive diagnostic value ofMPSPECT for left anterior descending coronary artery (LAD) stenosis was 36%, for leftcircumflex coronary artery (LCx) stenosis was 43%, and for right coronary artery (RCA) stenosiswas 16%. Specificity values were 36%, 82% and 13% respectively.Conclusion: Pharmacologic stress-rest MPSPECT imaging with dipyridamole in the same dayincreases diagnostic accuracy for detection of coronary artery disease (CAD) in patients withLBBB and LV dilatation. It should be considered that false positive ischemic results detected inRCA areas except for LAD areas in these patients also.

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