Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Europace. 2010 May;12(5):643-8. doi: 10.1093/europace/eup404. Epub 2009 Dec 17.
The role of coronary artery disease (CAD) in atrial fibrillation (AF) is poorly investigated. This study investigated the value of myocardial perfusion single-photon emission computed tomography (SPECT) in the assessment of risk of CAD in patients with a history of AF.
Out of consecutive patients without previous coronary angiogram or history of CAD referred for SPECT, patients with a history of AF (n = 129) were compared with age- and gender-matched controls (n = 124). Primary endpoint was positive SPECT, i.e. unambiguous signs of ischaemia. There was no significant difference with regard to positive SPECT outcome between AF patients and controls (14 patients, 11% vs. 21 patients, 17%; P = 0.16). Coronary angiography (CAG) performed after SPECT demonstrated a higher yield of positive SPECT regarding significant CAD in control patients (10 out of 15 patients, 67%) than in AF patients (2 out of 13 patients, 15%; P = 0.006).
Positive SPECT outcome was similar in patients with AF and in controls. Nevertheless, in AF patients a positive SPECT outcome was less often related to significant CAD in those patients who subsequently underwent CAG. These results emphasize the need for new non-invasive techniques to adequately assess the risk of significant CAD in AF patients.
冠状动脉疾病（CAD）在心房颤动（AF）中的作用研究不足。本研究旨在探讨心肌灌注单光子发射计算机断层扫描（SPECT）在评估有 AF 病史患者 CAD 风险中的价值。
连续入组无既往冠状动脉造影或 CAD 病史而行 SPECT 的患者，比较 AF 病史患者（n=129）与年龄和性别匹配的对照组（n=124）。主要终点是 SPECT 阳性，即明确存在缺血迹象。AF 患者与对照组之间 SPECT 阳性结果无显著差异（14 例，11% vs. 21 例，17%；P=0.16）。SPECT 后行冠状动脉造影（CAG）显示，对照组中 SPECT 阳性与显著 CAD 的相关性更高（15 例中有 10 例，67%），而 AF 患者中 SPECT 阳性与显著 CAD 的相关性更低（13 例中有 2 例，15%；P=0.006）。
AF 患者与对照组的 SPECT 阳性结果相似。然而，在随后接受 CAG 的 AF 患者中，SPECT 阳性结果与显著 CAD 的相关性较低。这些结果强调需要新的非侵入性技术来充分评估 AF 患者发生显著 CAD 的风险。
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