Journal
JOURNAL OF NUCLEAR CARDIOLOGY
Volume 28, Issue 3, Pages 981-988Publisher
SPRINGER
DOI: 10.1007/s12350-020-02398-5
Keywords
CAD; PET; SPECT; Left bundle branch block; Ventricular-paced rhythm
Funding
- National Institutes of Health [5-T32HL007843-23]
- Doris Duke Charitable Foundation
- Measey Foundation
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PET has higher diagnostic accuracy compared to SPECT for detecting obstructive CAD in patients with left bundle branch block (LBBB) or ventricular-paced rhythm (VPR).
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 = .01) to detect obstructive CAD. LBBB/VPR-related septal and anteroseptal defects were more common with SPECT compared to PET (septal: 72% vs 17%,P = .001; anteroseptal: 47% vs 8%,P = .02). Conclusions PET has higher diagnostic accuracy when compared to SPECT for the detection of obstructive CAD in patients with LBBB or VPR.
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