Mahesh K Vidula1, Philip Wiener2, Senthil Selvaraj1, Muhammad Shoaib Khan3, Usman Abdul Salam4, Chaitanya Rojulpote4, Scott D Metzler5, Srinivas Denduluri1, Marie Guerraty1, Howard Julien1, Paco E Bravo6,7,8. 1. Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA. 2. Division of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA. 3. Department of Medicine, Marshfield Clinic Health System, Marshfield, WI, USA. 4. Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 5. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 6. Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA. paco.bravo@pennmedicine.upenn.edu. 7. Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. paco.bravo@pennmedicine.upenn.edu. 8. Division of Cardiothoracic Imaging, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. paco.bravo@pennmedicine.upenn.edu.
Abstract
BACKGROUND: The difference in diagnostic accuracy of coronary artery disease (CAD) between vasodilator SPECT and PET myocardial perfusion imaging (MPI) in patients with left bundle branch block (LBBB) or ventricular-paced rhythm (VPR) is unknown. METHODS: We identified patients with LBBB or VPR who underwent either vasodilator SPECT or PET MPI and subsequent coronary angiography. LBBB/VPR-related septal and anteroseptal defects were defined as perfusion defects involving those regions in the absence of obstructive CAD in the left anterior descending artery or left main coronary artery. RESULTS: Of the 55 patients who underwent coronary angiography, 38 (69%) underwent SPECT and 17 patients (31%) underwent PET. PET compared to SPECT demonstrated higher sensitivity (88% vs 60%), specificity (56% vs 14%), positive predictive value (64% vs 20%), negative predictive value (83% vs 50%), and overall superior diagnostic accuracy (AUC .72 (95% CI .50-.93) vs .37 (95% CI .20-.54), P = .01) to detect obstructive CAD. LBBB/VPR-related septal and anteroseptal defects were more common with SPECT compared to PET (septal: 72% vs 17%, P = .001; anteroseptal: 47% vs 8%, P = .02). CONCLUSIONS: PET has higher diagnostic accuracy when compared to SPECT for the detection of obstructive CAD in patients with LBBB or VPR.
BACKGROUND: The difference in diagnostic accuracy of coronary artery disease (CAD) between vasodilator SPECT and PET myocardial perfusion imaging (MPI) in patients with left bundle branch block (LBBB) or ventricular-paced rhythm (VPR) is unknown. METHODS: We identified patients with LBBB or VPR who underwent either vasodilator SPECT or PET MPI and subsequent coronary angiography. LBBB/VPR-related septal and anteroseptal defects were defined as perfusion defects involving those regions in the absence of obstructive CAD in the left anterior descending artery or left main coronary artery. RESULTS: Of the 55 patients who underwent coronary angiography, 38 (69%) underwent SPECT and 17 patients (31%) underwent PET. PET compared to SPECT demonstrated higher sensitivity (88% vs 60%), specificity (56% vs 14%), positive predictive value (64% vs 20%), negative predictive value (83% vs 50%), and overall superior diagnostic accuracy (AUC .72 (95% CI .50-.93) vs .37 (95% CI .20-.54), P = .01) to detect obstructive CAD. LBBB/VPR-related septal and anteroseptal defects were more common with SPECT compared to PET (septal: 72% vs 17%, P = .001; anteroseptal: 47% vs 8%, P = .02). CONCLUSIONS: PET has higher diagnostic accuracy when compared to SPECT for the detection of obstructive CAD in patients with LBBB or VPR.
Entities:
Keywords:
CAD; Left bundle branch block; PET; SPECT; Ventricular-paced rhythm
Authors: Stephan D Fihn; Julius M Gardin; Jonathan Abrams; Kathleen Berra; James C Blankenship; Apostolos P Dallas; Pamela S Douglas; Joanne M Foody; Thomas C Gerber; Alan L Hinderliter; Spencer B King; Paul D Kligfield; Harlan M Krumholz; Raymond Y K Kwong; Michael J Lim; Jane A Linderbaum; Michael J Mack; Mark A Munger; Richard L Prager; Joseph F Sabik; Leslee J Shaw; Joanna D Sikkema; Craig R Smith; Sidney C Smith; John A Spertus; Sankey V Williams; Jeffrey L Anderson Journal: Circulation Date: 2012-11-19 Impact factor: 29.690