Pioch, N. (Naima) (2021) Diagnostic accuracy for detecting obstructive coronary artery disease in patients with left bundle branch block: Positron emission tomography myocardial perfusion imaging does not exceed accuracy of single-photon emission computed tomography. thesis, Medicine.
Full text available on request.Abstract
Introduction. Left bundle branch block (LBBB), a cardiac conduction abnormality which results in increased morbidity, is associated with septal-apical perfusion defects. Non-invasive detection of perfusion defects in patients with LBBB remains a challenge. In previous studies, a higher diagnostic accuracy was found for positron emission tomography (PET) myocardial perfusion imaging (MPI) compared with single-photon emission computed tomography (SPECT). This study aims to validate these findings, to assess differences in flow characteristics, and to identify predictors of major adverse cardiac events (MACE). Methods. In a retrospective cohort design, patients with LBBB underwent either PET MPI (n=172) or SPECT (n=249). Differences in flow characteristics between the groups were compared using scan outcomes. Diagnostic accuracy of PET MPI and SPECT were determined in terms of sensitivity and specificity with coronary angiography (CAG) as the gold standard, among patients who received CAG (n=53). Results. Equal sensitivity was found for PET MPI and SPECT (both 88%), but specificity was higher for PET MPI (55% vs. 30%). However, when corrected for defects due to LBBB, the specificity of SPECT increased to 60%. Concerning flow characteristics, SPECT revealed more septal-apical defects, which were false positives. For both scan methods, abnormal outcomes predicted earlier revascularization, MACE, and death. Furthermore, the risk of MACE increased with age, creatinine level, and calcium scores exceeding 400, and decreased with higher left ventricular ejection fraction. Conclusion. The study yielded no evidence for a higher diagnostic accuracy of PET MPI compared with SPECT in LBBB patients.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Elvan, A. and Daniëls, F. |
| Faculty: | Medical Sciences |
| Date Deposited: | 05 Jan 2022 11:13 |
| Last Modified: | 05 Jan 2022 11:13 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2945 |
Actions (login required)
 |
View Item |