Usefulness of Tc99m-MIBI myocardial perfusion SPECT in coronary artery disease diagnosis in women
Uniwersytet Medyczny w Poznaniu, II Klinika Kardiologii Katedry Kardiologii, kierownik Kliniki.Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego 08/2008; 25(146):115-9.
Coronary artery disease (CAD) in women remains a difficult diagnostic problem. The usefulness of exercise electrocardiography (EXT) in these patients is limited. The value of other noninvasive tests including Tc99m-MIBI single photon emission computed tomography (SPECT), is still to be determined. Aim of the study was to assess the usefulness of Tc99m-MIBI SPECT in the diagnosis of CAD in women in comparison to EXT MATERIAL AND METHODS: 48 women age 38-64 years (mean 50 +/- 6) with symptoms of CAD were included to the study. EXT ECG and Tc99m-MIBI SPECT with dipyridamole were performed in all patients. The diagnostic value of the tests was assessed in comparison to coronary angiography. Sensivity, specifity and accuracy were calculated according to the generally accepted rules. RESULTS: In 21 patients (44%) significant stenosis (> 50% diameter narrowing) in coronary angiography was found. In 18 (38%) of them single-vessel disease was detected. In 2 pts (4%) vasoconstriction was observed. EXT was positive in 28, negative in 17 and undiagnostic in 3 women with sensivity 72%, specificity 46% and an accuracy 58%. Perfusion defects were detected in 15 pts at rest and in 30 after dipyridamole infusion. MIBI SPECT had sensivity 91%, a specifity 60% and accuracy 74%. Evaluating tests enhanced sensivity to 100%, specifity to 71% and accuracy to 86%. SPECT sensivity was related to the localisation of coronary vessels changes: LAD 100%, Cx 66%, RCA 88% in case of single-vessel disease. CONCLUSION: Tc99m-MIBI SPECT proved to be a highly useful test in the diagnosis of CAD in women. Its diagnostic sensivity and accuracy is further enhanced by combination with ECG EXT. It has particular value in detection of one vessel disease.