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ȣ - 480020 118 |
Diagnostic values of myocardial SPECT to detect restenosis in asymptomatic patient were significantly affected by the accuracy of pre-intervention SPECT |
서울대학교의과대학 내과학교실; 서울대학교병원 임상의학연구소 심혈관연구실; 서울대학교병원 심혈관센터 |
박진식, 김용진, 구본권, 김효수, 손대원, 오병희, 이명묵, 박영배, 최윤식 |
Purpose :
The perfusion state of specific coronary artery territories of the myocardial SPECT might be affected by many factors. Some of those factors would not be altered by coronary intervention, such as presence of fixed defect or breast shadowing and so on. We assessed the hypothesis that the diagnostic values of SPECT to detect restenosis after coronary stenting in asymptomatic patients would be affected by the accuracy of pre-intervention SPECT.
Methods :
One hundred thirty nine patients(173 coronary territories) were prospectively enrolled and they underwent pre-intervention SPECT, clinical follow-up and SPECT/ coronary angiography (CAG) at 6 months.
Results :
After excluding 11 follow-up losses, overall restenosis rate was 26%. Of the patients with typical angina (n=36), 52.8% had restenosis. In asymptomatic patients, if the corresponding myocardial territories of the coronary lesions showed fixed defects the specificity of the SPECT was extremely low(23%), and if the myocardial territories showed no perfusion decrease in pre-intervention SPECT, the sensitivity was extremely low(17%)(table 1).
Conclusion:
In asymptomatic patients, the diagnostic values to detect restenosis were significantly affected by the accuracy of pre-intervention SPECT. If the patients’s pre-intervention SPECT showed false negative results or fixed defects, SPECT would not be a useful tool to detect restenosis.
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Table 1. Diagnostic values of the SPECT to detect
restenosis in asymptomatic patients
Result of Pre-intervention
SPECT |
Sensitivity
(%) |
Specificity
(%) |
Restenosis
(%) |
No perfusion decrease (n=52) |
17 |
98 |
11 |
Revesible perfusion
decrease
(n=44) |
90 |
44 |
23 |
Fixed defect with or without partial
reversibility
(n=41) |
100 |
23 |
24 |
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