Diagnostic accuracy of SPECT and PET myocardial perfusion imaging in patients with left bundle branch block or ventricul
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Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA Division of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, PA Department of Medicine, Marshfield Clinic Health System, Marshfield, WI Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA Division of Cardiothoracic Imaging, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
Received Jul 13, 2020; accepted Sep 24, 2020 doi:10.1007/s12350-020-02398-5
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 5 .01) to detect obstructive CAD. LBBB/VPRrelated septal and anteroseptal defects were more common with SPECT compared to PET (septal: 72% vs 17%, P 5 .001; anteroseptal: 47% vs 8%, P 5 .02). Conclusions. PET has higher diagnostic accuracy when compared to SPECT for the detection of obstructive CAD in patients with LBBB or VPR. (J Nucl Cardiol 2020) Key Words: CAD Æ PET Æ SPECT Æ Left bundle branch block Æ Ventricular-paced rhythm The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for reuse at meetings and presentations. Search for the article DOI on SpringerLink.com. The authors have also provided an audio summary of the article, which is available to download as ESM, or to listen to via the JNC/ASNC Podcast. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02398-5) contains supplementary material, which is available to authorized users.
Reprint requests: Paco E. Bravo, MD, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA 19104; [email protected] 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
Vidula et al. Diagnostic accuracy of SPECT and PET myocardial perfusion ima
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