Publish in this journal
Journal Information
Share
Share
Download PDF
More article options
ePub
Visits
...
Original article
Available online 19 April 2024
Diagnostic accuracy of anatomic vs functional tests for coronary artery disease in patients with left bundle branch block and right ventricular pacing
Precisión diagnóstica de las pruebas anatómicas frente a las funcionales para la enfermedad arterial coronaria en pacientes con bloqueo de rama izquierda y estimulación ventricular derecha
Visits
10
Diana Carvalhoa,
Corresponding author
, Pedro Carvalhob, Nuno Dias Ferreirac, Ana Faustinoa, Jesus Vianaa, Raquel Ferreiraa, José Luís Martinsd
a Department of Cardiology, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
b Department of Cardiology, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
c Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal
d Department of Cardiology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
This item has received
Received 01 November 2023. Accepted 19 March 2024
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Tables (3)
Table 1. Baseline characteristics of patients.
Table 2. Results of coronary angiography and diagnostic performance of SPECT-MPI, DSE and CTCA.
Table 3. Results of SPECT-MPI, DSE, and CTCA and characterization of true and false positive results.
Show moreShow less
Abstract
Introduction and objectives

A lower accuracy of functional tests for the diagnosis of significant coronary disease in patients with left bundle branch block (LBBB) has been described, due to a greater number of false positives. The aim of this study was to evaluate whether an anatomic test such as computerized tomography coronary angiogram (CTCA) outperforms SPECT myocardial perfusion imaging (SPECT-MPI) or dobutamine stress echocardiography (DSE) in the diagnosis of significant coronary artery disease in patients with LBBB and right ventricular pacing.

Methods

Observational study of 149 patients with LBBB and right ventricular pacing referred to SPECT-MPI, DSE or CTCA at three centers. Diagnostic performance (predictive accuracy, sensitivity, specificity, positive and negative predictive value) was evaluated using coronary angiography as the benchmark.

Results

The study included 77 patients who underwent SPECT-MPI, 39 who performed DSE and 33 who performed CTCA. The prevalence of obstructive coronary disease was similar in the three cohorts, with a higher rate of abnormal results on SPECT-MPI (84% vs 64% vs 61%; P=.009). Predicted accuracy was significantly lower in the SPECT-MPI group (39% vs 64% vs 67%; P=.006). DSE and CTCA showed a similar rate of abnormal results, as well as similar predictive accuracy (64% vs 67%; P>.999).

Conclusions

In patients with LBBB and right ventricular pacing, DSE and CTCA had similar accuracy and performed better than SPECT-MPI for the diagnosis of significant coronary artery disease.

Keywords:
Stress echocardiography
SPECT myocardial perfusion
Diagnostic imaging
Computed tomography angiography
Bundle branch block
Abbreviations:
CAD
CTCA
DSE
LBBB
RVP
SPECT-MPI
Resumen
Introducción y objetivos

Se ha descrito una menor precisión de las pruebas funcionales para el diagnóstico de la enfermedad coronaria significativa en pacientes con bloqueo de rama izquierda (BRI), debido a una mayor cantidad de falsos positivos. El propósito del presente estudio fue evaluar la superioridad de una prueba anatómica como la angiografía coronaria por tomografía computarizada (ACTC) respecto a pruebas de perfusión como son el SPECT de perfusión miocárdica (SPECT-MPI) o la ecocardiografía de estrés con dobutamina (EED) para el diagnóstico de la enfermedad arterial coronaria significativa en pacientes con BRI y estimulación ventricular derecha.

Métodos

Estudio observacional de 149 pacientes con BRI y estimulación ventricular derecha remitidos a SPECT-MPI, EED o ACTC en 3 centros. El rendimiento diagnóstico (precisión predictiva, sensibilidad, especificidad, valor predictivo positivo y negativo) se evaluó utilizando la angiografía coronaria invasiva como prueba de referencia.

Resultados

El grupo de estudio estuvo formado por 77 pacientes sometidos a SPECT-MPI, 39 a EED y 33 a ACTC. La prevalencia de enfermedad coronaria obstructiva fue similar en las 3 cohortes, con una mayor tasa de resultados anormales en la SPECT-MPI (84 frente al 64 frente al 61%; p=0,009). La precisión predictiva fue menor en el grupo SPECT-MPI (39 frente al 64 frente al 67%; p=0,006). La EED y la ACTC mostraron una tasa similar de resultados anormales, así como una precisión predictiva similar (64 frente al 67%; p>0,999).

Conclusiones

En pacientes con BRI y estimulación ventricular derecha, la EED y la ACTC no mostraron diferencias significativas entre ellas en el diagnóstico de enfermedad arterial coronaria significativa. Ambas presentaron mejores resultados respecto al SPECT-MPI.

Palabras clave:
Ecocardiografía de estrés
SPECT de perfusión miocárdica
Diagnóstico por imagen
Angiografía por tomografía computarizada
Bloqueo de rama

Article

These are the options to access the full texts of the publication REC: CardioClinics
Member
Socios SEC
Use datos de acceso a SEC en el menú Acceder.
Si es socio de la Sociedad Española de Cardiología y no puede acceder con sus claves, escriba a rec@cardioclinics.org.
Members of SEC
Use the Society's website login and password here.
If you are member of SEC and you have some problems with your login data, please contact with rec@cardioclinics.org.
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

REC: CardioClinics

Purchase
Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
Email
Idiomas
REC: CardioClinics
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?