medigraphic.com
ISSN 0185-3252 (Impreso)
Revista de la Asociación Médica del Centro Médico ABC

2015, Número 3

<< Anterior Siguiente >>

An Med Asoc Med Hosp ABC 2015; 60 (3)


Diagnóstico de enfermedad arterial coronaria en pacientes con bloqueo de la rama izquierda del haz de His: SPECT cardiaco versus angiotomografía coronaria

Parra LB, Bialostozky KD, Vallejo VE

Idioma: Español
Referencias bibliográficas: 34
Paginas: 191-198
Archivo PDF: 302.32 Kb.


RESUMEN

Antecedentes: El bloqueo de rama izquierda del haz de His se asocia a enfermedad arterial coronaria y muerte cardiovascular. Objetivo: Este estudio compara la certeza diagnóstica de la tomografía computarizada con emisión de fotón único y la angiotomografía coronaria en la detección de enfermedad coronaria en pacientes con bloqueo de rama izquierda. Métodos: Se incluyeron 23 pacientes a quienes se les realizó tomografía computarizada con emisión de fotón único cardiaco y angiotomografía coronaria. La certeza diagnóstica de ambos métodos para detectar enfermedad arterial coronaria (› 50% de estenosis) fue comparada con angiografía coronaria invasiva. Resultados: La tomografía computarizada con emisión de fotón único cardiaco identificó correctamente 8 de 14 pacientes sin enfermedad coronaria significativa y 8 de 9 pacientes con estenosis › 50%. La angiotomografía coronaria identificó correctamente 12 de 14 pacientes sin enfermedad coronaria significativa y los 9 pacientes de 9 con estenosis › 50%. La certeza diagnóstica global, sensibilidad, especificidad, valor predictivo positivo y negativo para la tomografía computarizada con emisión de fotón único cardiaco fueron 69, 88, 57, 57 y 88% respectivamente y para la angiotomografía coronaria fueron 91, 100, 85, 81 y 100%. Conclusiones: La certeza diagnóstica de la angiotomografía coronaria para detectar enfermedad arterial coronaria en pacientes con bloqueo de rama izquierda es mayor, por lo que podría proponerse como el primer método de imagen no invasiva en la evaluación de pacientes con estas características.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Iskandrian AE. Detecting coronary artery disease in left bundle branch block. J Am Coll Cardiol. 2006; 48: 1935-1937.

  2. Makan M, Pérez JE. Perspectivas sobre la utilización de las modalidades de imagen de estrés en la valoración inicial de la cardiopatía isquémica. Rev Esp Cardiol. 2003; 56: 1010-1015.

  3. Geleijnse M, Vigna C, Kasprzak J, Rambaldi R, Salvatori M, Elhendy A et al. Usefulness and limitations of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicenter study. Eur Heart J. 2000; 21: 1666-1673.

  4. Lebthani NE, Stauffer JC, Delaloye AB. Left bundle branch block and coronary artery disease: accuracy of dipyridamole thallium-201 single photon emission computed tomography in patients with exercise anteroseptal perfusion defects. J Nucl Cardiol. 1997; 4: 166-273.

  5. Gopalakrisham P, Wilson GT, Tak T. Accuracy of multislice computed tomography coronary angiography. A pooled estimate. Cardiol in Rev. 2008; 16: 189-196.

  6. Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of the heart and great vessels. 9th ed. Boston, MA: Little Brown; 1994: 210-219.

  7. Hansen CL. ASNC imaging guidelines for nuclear cardiology procedures. myocardial perfusion and function. Single photon emission computed tomography. J Nucl Cardiol. 2007; 14: e39-e60.

  8. Cerqueira MD, Wejssman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professional from the cardiac imaging committee of the council on clinical cardiology of the American Heart Association. J Nucl Cardiol. 2002; 105: 539-542.

  9. Vallejo E, Morales M, Sánchez I, Sánchez G, Alburez JC, Bialostozky D. Myocardial perfusion SPECT imaging in patients with myocardial bridging. J Nucl Cardiol. 2005; 12: 318-323.

  10. 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: 5-40.

  11. Gibbons RJ, Balady GJ, Bricker T, Chaitman BR, Fletcher GF, Froelicher VF et al. ACC/AHA 2002 guidelines update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to update the 1997 exercise testing guidelines). Circulation. 2002; 106: 1883-1892.

  12. Wackers FJ. Artifacts in planar and SPECT myocardial perfusion imaging. Am J Cardiac Imaging. 1992; 6: 42-58.

  13. Shecyk JF, Gingrich S, Nino AF, Wackers FJ. Altered left ventricular depolarization sequence in left bundle branch block is not a cause for false positive thallium-201 defects. J Am Coll Cardiol. 1991; 17: 78a.

  14. One S, Nohara R, Kaambaqra H, Okuda K, Kawai CÑ. Regional myocardial perfusion and glucose metabolism in experimental left bundle branch block. Circulation. 1992; 85: 1125-1131.

  15. Wackers FJ. Myocardial perfusion defects in left bundle branch block: true or false? Fact or artifact? J Nucl Cardiol. 1997; 4: 550-552.

  16. Iskandrian AE. Detecting coronary artery disease in left bundle branch block. J Am Coll Cardiol. 2006; 48: 1935-1937.

  17. Hamon M, Morello R, Riddell JW, Hamon M. Performance of 16- versus 64- section spiral ct compared with invasive coronary angiography – meta-analysis. Radiology. 2007; 245: 720-731.

  18. Hoffman U, Ferencik M, Cury RC, Peña AJ. Coronary CT angiography. J Nucl Med. 2006; 47: 797-806.

  19. Schuijf JD, Pundziute G, Jukema JW, Lamb HJ, van der Hoeven BL, de Roos A et al. Diagnostic accuracy of 64-slice multislice computed tomography in the noninvasive evaluation of significant coronary artery disease. Am J Cardiol. 2006; 98: 145-148.

  20. Ghostine S, Caussin C, Coud 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: 1929-1934.

  21. Andreini D, Pontone G, Bartorelli AL, Agostini P, Mushtaq S, Bertella E et al. Sixty-four-slice multidetector computed tomography: an accurate imaging modality for the evaluation of coronary arteries in dilated cardiomyopathy of unknown etiology. Circ Cardiovasc Imaging. 2009; 2: 199-205.

  22. Hoefflinghaus T, Husmann I, Valenta I, Moonen C, Gaemperli O, Schepis T et al. Role of attenuation correction to discriminate defects caused by left bundle branch block versus coronary stenosis in single photon emission compute tomography myocardial perfusion imaging. Clin Nucl Med. 2008; 33 (11): 748-751.

  23. Raggi P, Berman DS. Computed tomography coronary calcium screening and myocardial perfusion imaging. J Nucl Cardiol. 2005; 12: 96-103.

  24. Sarwar A, Shaw LJ, Shapiro MD, Blankstein R, Hoffman U, Cury RC et al. Diagnostic and prognostic value of absence of coronary artery calcification. J Am Coll Cardiol Img. 2009; 2: 675-688.

  25. Schneider JF, Thomas HE, Sorlie P, Kreger BE, McNamara PM, Kannel WB. Comparative features of newly acquired left and right bundle branch block in the general population: the Framingham study. Am J Cardiol. 1981; 47: 931-940.

  26. Hesse B, Díaz 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: 253-259.

  27. George RT, Arbab-Zadeh A, Miller JM, Kitagawa K, Chang HJ, Bluemke DA et al. Adenosine stress 64 and 256 row detector computed tomography angiography and perfusion imaging: a pilot study evaluating the transmural extent of perfusion abnormalities to predict atherosclerosis causing myocardial ischemia. Circ Imaging. 2009; 2 (3): 174-182.

  28. Ghostine G, Caussin C, Daoud B, Habis M, Perrier E. 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: 1929-1934.

  29. Ruzcics B, Lee H, Zwerner PL, Gebregziabher M, Costello P, Shoepf UJ. Dual-energy CT of the heart for diagnosing coronary artery stenosis and myocardial ischemia. Initial experience. Eur Radiol. 2008; 18: 2414-2424.

  30. Nowak B, Stellbrink C, Schaefer WM, Sinha AM, Breithardt OA. Comparison of regional myocardial blood flow and perfusion in dilated cardiomiopathy and left bundle branch block: role of wall thickening. J Nucl Med. 2004; 45: 414-418.

  31. Hayat SA, Dwivedi G, Jacobsen A, Lim TK, Kinsey C. Effects of left bundle-branch block on cardiac structure, function, perfusion and perfusion reserve. Implications for myocardial contrast echocardiography versus radionuclide perfusion imaging for the detection of coronary artery disease. Circulation. 2008; 117: 1832-1841.

  32. Duncan AM, Francis DP, Gibson DG, Henein MY. Differentiation of ischemic form non ischemic cardiomiopathy during dobutamine stress by left ventricular long-axis function. Additional effect of left bundle-branch block. Circulation. 2003; 108: 1214-1220.

  33. Iskandrian AE. Detecting coronary artery disease in left bundle branch block. J Am Coll Cardiol. 2006; 48: 1935-1937.

  34. Badran MH, Elnoamany FM, Seteha M. Tissue velocity imaging with dobutamine stress echocardiography – A quantitative technique for identification of coronary artery disease in patients with left bundle-branch block. J Am Soc Echocardiogr. 2007; 20: 820-831.




2020     |     www.medigraphic.com