Authors
1
1-Nuclear Medicine Department, Rajaei Cardiovascular, Medical & Research Center; Tehran University of Medical Sciences, Tehran, Iran Vali-Asr Ave., Niyayesh Blvd.
2
-Nuclear Medicine Department, Rajaei Cardiovascular, Medical & Research Center; Tehran University of Medical Sciences, Tehran, Iran Vali-Asr Ave., Niyayesh Blvd.
3
Nuclear Medicine Department, Rajaei Cardiovascular, Medical & Research Center; Tehran University of Medical Sciences, Tehran, Iran Vali-Asr Ave., Niyayesh Blvd
4
Nuclear Medicine Department, Rajaei Cardiovascular, Medical & Research Center; Tehran University of Medical Sciences, Tehran, Iran Vali-Asr Ave., Niyayesh Blvd.
5
Guilan University of Medical Sciences, Rasht, Iran,
Abstract
Introduction- Nowadays, myocardial perfusion imaging (MPI) plays an important role in the early diagnosis of patients with coronary artery disease (CAD). This study sought to assess the performance of MPI alongside chest pain and ST-segment changes during the stress test by comparison with angiography in the diagnosis of coronary artery stenosis. To that end, the accuracy of these modalities in terms of sensitivity and specificity and the degree of greement between their results in the diagnosis of coronary artery stenosis were evaluated.
Methods and Materials- The study population, selected from those with known or suspected CAD, was comprised of 85 patients (67 males) at a mean age of 53.7 ± 9.6 years. All the patients were subjected to SPECT imaging of the blood supply to the heart muscle during a two-day state of stress (either pharmacologically with Dipyridamole or through exercise test) and during rest via the injection of 99m Tc - MIBI. ST-segment changes during stress as well as clinical symptoms were recorded. All the patients underwent coronary angiography within two weeks, and coronary artery stenosis>50% was considered positive. Finally, the results of chest pain, ECG changes, and MPI for the evaluation of coronary artery involvement were compared with those of angiography as the gold standard.
Results- Of the 85 patients, who underwent angiography, 10 patients had normal coronary angiography, 22 single-vessel disease, 28 two-vessel disease, and 25 three-vessel disease. ST-segment depression and ST-segment elevation were observed in 40 and 6 patients, respectively. The ECG had sensitivity of 57% and specificity of 70% in the diagnosis of coronary artery stenosis. Fifteen patients had chest pain during stress; all of them had coronary involvement according to angiography. Of the 70 patients with no chest pain, coronary angiography was positive in 62 cases; accordingly, chest pain had sensitivity of 20% and specificity of 100% in the diagnosis of coronary artery stenosis. There were 80 patients with abnormal MPI, including 387 fixed and reversible defects. Therefore, MPI had sensitivity of 79%, specificity of 70%, and diagnostic accuracy of 76% in the diagnosis of coronary artery stenosis.
Conclusion- MPI enjoyed higher diagnostic accuracy and agreement coefficient than did chest pain and ST-segment changes in the diagnosis of coronary artery stenosis.Given the acceptable results of MPI in the diagnosis of coronary artery stenosis, this modality could be valuable in the management of CAD patients.
Keywords
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