Pavlovic Smiljana, Sobic-Saranovic Dragana, Djordjevic-Dikic Ana, Beleslin Branko, Stepanovic Jelena, Artiko Vera, Giga Vojislav, Petrasinovic Zorica, Ostojic Miodrag, Vujisic-Tesic Bosiljka, Obradovic Vladimir
Institute of Nuclear Medicine, Belgrade, Serbia.
Nucl Med Commun. 2010 Apr;31(4):334-40. doi: 10.1097/MNM.0b013e328335e5f2.
To compare the diagnostic utility of gated single-photon emission computed tomography (SPECT) methoxy isobutyl isonitrile (MIBI) myocardial perfusion imaging and transthoracic Doppler echocardiography (TTDE) coronary flow reserve (CFR) to coronary angiography for detecting coronary artery disease (CAD) in patients with left bundle branch block (LBBB).
Forty-three patients with complete LBBB and an intermediate pretest probability for CAD underwent dipyridamole stress TTDE and gated SPECT MIBI during the same session and coronary angiography within a month. The parameters of myocardial perfusion (summed stress score, summed difference scores) regional wall function (wall motion score, wall thickening score) and ejection fraction were derived using the 17-segment model and 4D-MSPECT software. TTDE variables included peak flow velocity at rest and during hyperemia in left anterior descending artery (LAD), based on which CFR was calculated (normal>2).
Perfusion ischemic scores were significantly higher in group 1 with angiographic evidence of greater than 50% LAD stenosis compared with group 2 with less than 50% LAD stenosis (summed stress score 12.4+/-5.5 vs. 8.3+/-3.5, P<0.05, summed difference score 3.7+/-1.2 vs. 1.1+/-0.3, P<0.01, respectively). Left ventricular regional wall function and ejection fraction were not different between the two groups. CFR was significantly lower in group 1 than in group 2 (1.65+/-0.21 vs. 2.31+/-0.28, P<0.001). Gated SPECT MIBI and CFR had similar sensitivity (88 vs. 88%), specificity (80 vs. 84%), and accuracy (84 vs. 86%) for detecting CAD in patients with LBBB. The agreement between the two methods was 85%.
Our results show comparable diagnostic utility and high agreement between gated SPECT MIBI perfusion imaging and TTDE CFR assessment for detecting CAD in patients with LBBB. The advantage of gated SPECT MIBI over TTDE CFR measurements is the ability to assess the perfusion abnormalities in multiple vascular territories during the same procedure, which is convenient for detecting multi-vessel disease in patients with LBBB.
比较门控单光子发射计算机断层扫描（SPECT）甲氧基异丁基异腈（MIBI）心肌灌注成像和经胸多普勒超声心动图（TTDE）冠状动脉血流储备（CFR）与冠状动脉造影在检测左束支传导阻滞（LBBB）患者冠状动脉疾病（CAD）方面的诊断效用。
43例LBBB且CAD预测试概率为中等的患者在同一时段接受双嘧达莫负荷TTDE和门控SPECT MIBI检查，并在1个月内进行冠状动脉造影。使用17节段模型和4D-MSPECT软件得出心肌灌注参数（负荷总分、差值总分）、局部室壁功能（室壁运动评分、室壁增厚评分）和射血分数。TTDE变量包括左前降支（LAD）静息和充血时的峰值流速，并据此计算CFR（正常>2）。
与LAD狭窄小于50%的2组相比，LAD狭窄大于50%且有血管造影证据的1组灌注缺血评分显著更高（负荷总分12.4±5.5对8.3±3.5，P<0.05；差值总分3.7±1.2对1.1±0.3，P<0.01）。两组间左心室局部室壁功能和射血分数无差异。1组的CFR显著低于2组（1.65±0.21对2.31±0.28，P<0.001）。门控SPECT MIBI和CFR在检测LBBB患者CAD方面具有相似的敏感性（88%对88%）、特异性（80%对84%）和准确性（84%对86%）。两种方法之间的一致性为85%。
我们的结果表明，门控SPECT MIBI灌注成像和TTDE CFR评估在检测LBBB患者CAD方面具有相当的诊断效用和高度一致性。门控SPECT MIBI相对于TTDE CFR测量的优势在于能够在同一检查过程中评估多个血管区域的灌注异常，这便于检测LBBB患者的多支血管病变。
