The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block

GÖL, Kamil; DEMİRCAN, Sabri; ELMALI, Muzaffer; Nural, Mehmet Selim; yazıcı, mustafa

The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block

Mehmet Selim NURAL, (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Radyoloji Anabilim Dalı, Samsun, Türkiye)

Mustafa YAZICI, (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Samsun, Türkiye)

Muzaffer ELMALI, (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Radyoloji Anabilim Dalı, Samsun, Türkiye)

Sabri DEMİRCAN, (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Samsun, Türkiye)

Kamil GÖL (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, Samsun, Türkiye)

Anadolu Kardiyoloji Dergisi

0 1

Yıl: 2008 Cilt: 8 Sayı: 2 Sayfa Aralığı: 128 - 133 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block

Öz:

Koroner arter hastalığına eşlik eden sol dal bloklu (LBBB) hastalarda noninvazif tanı yöntemleri yeterli veri sağlamamaktadır. Bu yüzden, bu hastalarda genellikle koroner anjiyografiye gerek duyulmaktadır. Bizim amacımız, multidetektörlü bilgisayarlı tomografik (MSCT) koroner anjiyografinin, LBBB’li hastalarda koroner arter hastalığını tespit etmede kullanılabilirliğini değerlendirmektir. Yöntemler: Kesitsel çalışmaya kantitatif koroner anjiyografide %50’nin üzerinde darlık saptanan LBBB’li 61 hasta (31 erkek, 30 kadın, yaş ortalaması 56±13) alındı. Hastalara EKG senkronizasyon ünitesi olan 16-detektörlü MSCT scanner cihazı ile MSCT koroner anjiyografi yapıldı. Elde edilen MSCT koroner anjiyografi görüntülerinde her koroner arter segmental olarak değerlendirildi ve koroner arterlerde %50’nin üzerindeki darlıklar belirlendi. Bulgular: Çalışmaya katılan 61 hastada, MSCT koroner anjiyografi ile elde edilen 793 koroner arter segmentinin (her hasta için 13 segment) verileri, konvansiyonel koroner anjiyografi sonuçları ile karşılaştırıldı. Tüm segmentler dahil edildiğinde MSCT koroner anjiyografinin %50’nin üzerinde anlamlı darlıkları saptamadaki, tanı doğruluğu, sensitivite, spesifisite, pozitif ve negatif prediktif değerleri sırasıyla %91, %67, %97, %85 ve %92 olarak bulundu. Ayrıca, MSCT koroner anjiyografinin hastalarda en az bir koroner arter segment darlığını saptamadaki sensitivitesinin %80, spesifisitesinin %90 olduğu gözlendi. Sonuç: Multidetektörlü bilgisayarlı tomografik koroner anjiyografi, sol dal bloklu hastalarda koroner arter hastalığını belirlemede noninvazif bir tanı yöntemi olarak kullanılabilir. (Anadolu Kardiyol Derg 2008; 8: 128-33)

Anahtar Kelime: Duyarlılık ve özgüllük Koroner arter hastalığı Kesitsel çalışmalar Tomografi, x-ışınlı bilgisayarlı Dal bloğu Testlerin kestirim değeri

Konular: Kalp ve Kalp Damar Sistemi

Sol dal bloklu hastalarda koroner arter hastalığını belirlemede multidetektörlü bilgisayarlı tomografinin değeri

Öz:

Noninvasive diagnostic methods do not supply sufficient data for patients with left bundle branch block (LBBB) accompanied with coronary artery diseases (CAD). Therefore, generally coronary angiography is required for these patients. Our aim was to evaluate the diagnostic value of multislice spiral computed tomographic (MSCT) coronary angiography to detect CAD in patients with LBBB. Methods: Sixty one patients (31 males, 30 females, mean age: 56±13 years) with LBBB who have determined stenosis higher than 50% in quantitative coronary angiography were included in the cross-sectional study. The MSCT coronary angiography was applied to the patients with a 16-detector MSCT scanner that has an electrocardiographic synchronization unit. Each coronary artery was evaluated segmentally in the images acquired from MSCT coronary angiographies and any detected stenosis higher than 50% was recorded. Results: The data of 793 coronary artery segments achieved from MSCT coronary angiographies of 61 patients (13 segments for each patient) were compared with the results of conventional coronary angiographies of the same patients. When all the segments evaluated were included in this comparison, the diagnostic accuracy, sensitivity, specificity, positive and negative predictive values of MSCT coronary angiography to detect stenosis higher than 50% were 91%, 67%, 97%, 85% and 92%, respectively. Also, it was observed that, MSCT coronary angiography has 80% sensitivity and 90% specificity to detect, at least, one segment coronary artery stenosis. Conclusion: The MSCT coronary angiography can be utilized as a noninvasive diagnostic method for patients with LBBB, in order to evaluate coronary artery disease. (Anadolu Kardiyol Derg 2008; 8: 128-33)

Anahtar Kelime: Bundle-Branch Block Predictive Value of Tests Sensitivity and Specificity Coronary Artery Disease Cross-Sectional Studies Tomography, X-Ray Computed

Konular: Kalp ve Kalp Damar Sistemi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Schneider JF, Thomas HE, McNamara PM, Kannel WB. Clinical-electrocardiographic correlates of newly acquired left bundle branch block: the Framingham Study. Am J Cardiol 1985; 55: 1332-8.
2. Hesse B, Diaz LA, Snader CE, Blackstone EH, Lauer MS. Complete bundle branch block as an independent predictor of all-cause mortality: report of 7,073 patients referred for nuclear exercise testing. Am J Med 2001; 110: 253-9.
3. Freedman RA, Alderman EL, Sheffield LT, Saporito M, Fisher LD. Bundle branch block in patients with chronic coronary artery disease: angiographic correlates and prognostic significance. J Am Coll Cardiol 1987; 10: 73-80.
4. Whinnery JE, Froelicher VF Jr, Stewart AJ, Longo MR Jr, Triebwasser JH, Lancaster MC. The electrocardiographic response to maximal treadmill exercise of asymptomatic men with left bundle branch block. Am Heart J 1977; 94: 316-24 .
5. Ibrahim NS, Abboud G, Selvester RS, Hagar JM, Ellestad MH. Detecting exercise-induced ischemia in left bundle branch block using the electrocardiogram. Am J Cardiol 1998; 82: 832-5.
6. Burns RJ, Galligan L, Wright LM, Lawand S, Burke, RI, Gladstone PI. Improved specificity of myocardial thallium-201 single-photon emission tomography in patients with left bundle branch block by dipyridamole. Am J Cardiol 1991; 68: 504-8.
7. Larcos G, Gibbons RJ, Brown ML. Diagnostic accuracy of exercise thallium-201 single-photon emission computed tomography in patients with left bundle branch block. Am J Cardiol 1991; 68: 756-60.
8. O’Keefe JH, Bateman TM, Barnhart CS. Adenosine thallium-201 is superior to exercise thallium-201 for detecting coronary artery disease in patients with left bundle branch block. J Am Coll Cardiol 1993; 21: 1332-8.
9. Mairesse GH, Marwick TH, Arnese M, Vanoverschelde JL, Cornel JH, Detry JM, et al. Improved identification of coronary artery disease in patients with left bundle branch block by use of dobutamine stress echocardiography and comparison with myocardial perfusion tomography. Am J Cardiol 1995; 76: 321-5.
10. Delonca J, Camenzind E, Meier B, Righetti A. Limits of thallium-201 exercise scintigraphy to detect coronary disease in patients with complete and permanent bundle branch block: a review of 134 cases. Am Heart J 1992; 123: 1201-7.
11. Vaduganathan P, He ZX, Raghavan C, Mahmarian JJ, Verani MS. Detection of left anterior descending coronary artery stenosis in patients with left bundle branch block: exercise, adenosine or dobutamine imaging? J Am Coll Cardiol 1996; 28: 543-50.
12. Wei K, Crouse L, Weiss J, Villanueva F, Schiller NB, Naqvi TZ, et al. Comparison of usefulness of dipyridamole stress myocardial contrast echocardiography to technetium-99m sestamibi single-photon emission computed tomography for detection of coronary artery disease (PB127 Multicenter Phase 2 Trial results). Am J Cardiol 2003; 91: 1293-8.
13. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 1975; 51(Suppl 4): 5-40.
14. Jain AC, Mehta MC. Etiologies of left bundle branch block and correlations with hemodynamic and angiographic findings. Am J Cardiol 2003; 91: 1375-8.
15. Iskandrian AE, Verani MS. Nuclear Cardiac Imaging: Principles and Applications. 3rd ed. New York: Oxford University Press; 2003.
16. Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol 2003; 42: 1318-33.
17. Alexanderson E, Mannting F, Gomez-Martın D, Fermon S, Meave A. Technetium-99m-Sestamibi SPECT myocardial perfusion imaging in patients with complete left bundle branch block. Arch Med Res 2004; 35: 150-6.
18. Iskandrian AE. Detecting coronary artery disease in left bundle branch block. J Am Coll Cardiol 2006; 48: 1935-37.
19. America YGCJ, Bax JJ, Boersma E, Stokkel M, van der Wall EE. Prognostic value of gated SPECT in patients with left bundle branch block. J Nucl Cardiol 2007; 14: 75-81.
20. Mahnken AH, Koos R, Katoh M, Wildberger JE, Spuentrup E, Buecker A, et al. Assessment of myocardial viability in reperfusedacute myocardial infarction using 16-slice computed tomography in comparison to magnetic resonance imaging. J Am Coll Cardiol 2005; 45: 2042-7.
21. Morgan-Hughes GJ, Roobottom CA, Owens PE, Marshall AJ. Highly accurate coronary angiography with submillimetre, 16-slice computed tomography. Heart 2005; 91: 308-13.
22. Ropers D, Baum U, Pohle K, Anders K, Ulzheimer S, Ohnesorge B, et al. Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation 2003; 107: 664-6.
23. Nieman K, Cademartiri F, Lemos PA, Raaijmakers R, Pattynama PM, de Feyter PJ. Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography. Circulation 2002; 106: 2051-4.
24. Kuettner A, Trabold T, Schroeder S, Feyer A, Beck T, Brueckner A, et al. Noninvasive detection of coronary lesions using 16-detector multislice spiral computed tomography technology: initial clinical results. J Am Coll Cardiol 2004; 44: 1230-7.
25. Andreini D, Pontone G, Pepi M, Balerini G,Bartorelli AL, MaginiA, et al. Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with dilated cardiomyopathy. J Am Coll Cardiol 2007; 49: 2044-50.
26. Ghostine S, Caussin C, Daoud B, Habis M, Perrier E, Pesenti-Rossi D, et al. Non-invasive detection of coronary artery disease in patients with left bundle branch block using 64-slice computed tomography. J Am Coll Cardiol 2006; 48: 1929-34.
27. Haberl R, Tittus J, Bohme E, Czernik A, Richartz BM, Buck J, et al. Multislice spiral computed tomographic angiography of coronary arteries in patients with suspected coronary artery disease: an effective filter before catheter angiography? Am Heart J 2005; 149: 1112-9.
28. Heuschmid M, Kuettner A, Schroeder S, Trabold T, Feyer A, Seemann MD, et al. ECG-gated 16-MDCT of the coronary arteries: assessment of image quality and accuracy in detecting stenoses. AJR Am J Roentgenol 2005; 184: 1413-9.
29. Rumberger JA, Behrenbeck T, Breen JF, Sheedy PF 2nd. Coronary calcification by electron beam computed tomography and obstructive coronary artery disease: a model for costs and effectiveness of diagnosis as compared with conventional cardiac testing methods. J Am Coll Cardiol 1999; 33: 453-62.

APA	Nural M, yazıcı m, ELMALI M, DEMİRCAN S, GÖL K (2008). The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block. , 128 - 133.
Chicago	Nural Mehmet Selim,yazıcı mustafa,ELMALI Muzaffer,DEMİRCAN Sabri,GÖL Kamil The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block. (2008): 128 - 133.
MLA	Nural Mehmet Selim,yazıcı mustafa,ELMALI Muzaffer,DEMİRCAN Sabri,GÖL Kamil The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block. , 2008, ss.128 - 133.
AMA	Nural M,yazıcı m,ELMALI M,DEMİRCAN S,GÖL K The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block. . 2008; 128 - 133.
Vancouver	Nural M,yazıcı m,ELMALI M,DEMİRCAN S,GÖL K The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block. . 2008; 128 - 133.
IEEE	Nural M,yazıcı m,ELMALI M,DEMİRCAN S,GÖL K "The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block." , ss.128 - 133, 2008.
ISNAD	Nural, Mehmet Selim vd. "The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block". (2008), 128-133.

APA	Nural M, yazıcı m, ELMALI M, DEMİRCAN S, GÖL K (2008). The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block. Anadolu Kardiyoloji Dergisi, 8(2), 128 - 133.
Chicago	Nural Mehmet Selim,yazıcı mustafa,ELMALI Muzaffer,DEMİRCAN Sabri,GÖL Kamil The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block. Anadolu Kardiyoloji Dergisi 8, no.2 (2008): 128 - 133.
MLA	Nural Mehmet Selim,yazıcı mustafa,ELMALI Muzaffer,DEMİRCAN Sabri,GÖL Kamil The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block. Anadolu Kardiyoloji Dergisi, vol.8, no.2, 2008, ss.128 - 133.
AMA	Nural M,yazıcı m,ELMALI M,DEMİRCAN S,GÖL K The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block. Anadolu Kardiyoloji Dergisi. 2008; 8(2): 128 - 133.
Vancouver	Nural M,yazıcı m,ELMALI M,DEMİRCAN S,GÖL K The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block. Anadolu Kardiyoloji Dergisi. 2008; 8(2): 128 - 133.
IEEE	Nural M,yazıcı m,ELMALI M,DEMİRCAN S,GÖL K "The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block." Anadolu Kardiyoloji Dergisi, 8, ss.128 - 133, 2008.
ISNAD	Nural, Mehmet Selim vd. "The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block". Anadolu Kardiyoloji Dergisi 8/2 (2008), 128-133.