Myocardial perfusion single-photon emission computer tomography and coronary angiography results in patients with different pretest probability of ischemic heart disease

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Abstract


Aim. To study the relationship between pretest probability (PTP) of ischemic heart disease (IHD), calculated according to the recommendations of the European Society of Cardiology (ESC) of 2013 and 2019, with the perfusion of the left ventricle of the myocardium according to the single-photon emission tomography (SPECT) and the results of the invasive coronary angiography (CAG).

Material and methods. The study included 220 patients with a preliminary diagnosis of ischemic heart disease and planned invasive CAG. All patients underwent rest-stress perfusion myocardial SPECT within 1 month prior to or after CAG, standard quantitative parameters of left ventricular perfusion were assessed. Retrospectively clinical data was analyzed and PTP of IHD was assessed according to ESC recommendations for 2013 and 2019.

Results. Invasive CAG revealed obstructive lesion of one or more coromary arteries in 204 of the 220 patients (92.7%). In a retrospective analysis, taking into account gender, age and nature of the complaints, as recommended by ESC in 2013, PTP was rated as low (<15%) in 13 patients (5.9%), as intermediate (15–85%) – in 207 patients (94.1%). Following the comprehensive survey (SPECT and CAG) 8 patients with low PTP (61.5%) underwent coronary revascularization. Among patients with intermediate PTP significant transient ischemia according to SPECT was detected in 31 (15.0%), initial – at 107 (51.7%). According CAG among patients with intermediate PTP obstructive lesion was found in 192 (92.7%), 113 patients (58.8%) underwent revascularization. According to ESC recommendations of 2019, PTP was rated as low (<15%) in 117 patients (53.2%), including 5–14% – in 98 (44.5%). According to a survey (SPECT and CAG) 68 of them (58.1%) underwent revascularization.

Conclusion. PTP measurements proposed by ESC can not be applied to patients of the Russian population with suspected ischemic heart disease without significant corrections. 2013 ESC recommendations with higher PTP values for all categories of patients reflect Russian population better, while 2019 recommendations mistakenly attribute patients to low PTP in at least 58% of cases. These results are preliminary and will be expanded in subsequent studies with more detailed analysis of PTP in included patients with suspected IHD.


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About the authors

A. A. Ansheles

National Medical Research Center for Cardiology

Author for correspondence.
Email: a.ansheles@gmail.com
ORCID iD: 0000-0002-2675-3276

Russian Federation, Moscow

д.м.н., с.н.с. отд. радионуклидной диагностики и ПЭТ

I. V. Sergienko

National Medical Research Center for Cardiology

Email: a.ansheles@gmail.com

Russian Federation, Moscow

д.м.н., гл.н.с. лаб. фенотипов атеросклерозов

E. I. Denisenko-Kankiya

City Clinical Hospital №4

Email: a.ansheles@gmail.com

Russian Federation, Moscow

зав. отд-нием радиоизотопной диагностики

V. B. Sergienko

National Medical Research Center for Cardiology

Email: a.ansheles@gmail.com

Russian Federation, Moscow

д.м.н., проф., рук. отд. радионуклидной диагностики и ПЭТ

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