Do electrocardiographic changes with adenosine myocardial perfusion imaging predict ischaemia in patients with left
Aseem Vashist1, Alejandro Victoria, Steve Blum
1Department of Medicine, Bronx-Lebanon Hospital Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10457, USA.
Insights
Electrocardiogram (ECG) changes during adenosine myocardial perfusion imaging (MPI) are highly specific for detecting ischaemia in patients with left ventricular hypertrophy (LVH). These ECG findings during stress testing hold similar significance for diagnosing cardiac issues in LVH patients as in those without LVH.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Tools
Background:
- Electrocardiogram (ECG) changes during adenosine myocardial perfusion imaging (MPI) are linked to severe coronary artery disease.
- The predictive value of these ECG changes in patients with left ventricular hypertrophy (LVH) remains unclear.
Purpose of the Study:
- To determine if ECG changes observed during adenosine MPI can predict myocardial ischaemia in patients diagnosed with LVH.
Main Methods:
- Retrospective analysis of 454 patients undergoing adenosine MPI.
- Baseline ECGs were reviewed to identify LVH.
- Adenosine stress was administered at 140 µg/kg/min for 6 minutes with Tc-sestamibi injection.
Main Results:
- In patients with LVH, stress ECG changes had 12.5% sensitivity and 95.3% specificity for predicting ischaemia on MPI.
- Positive and negative predictive values for ECG changes in LVH patients were 50% and 74.3%, respectively.
- Ischaemia was identified on MPI in 40 of 146 LVH patients and 68 of 308 non-LVH patients.
Conclusions:
- ECG changes during adenosine MPI are highly specific indicators of myocardial ischaemia in patients with LVH.
- The diagnostic significance of these ECG changes in LVH patients is comparable to that in patients without LVH.
Background:
Electrocardiographic (ECG) changes during adenosine myocardial perfusion imaging (MPI) correlate with severe coronary artery disease and the presence of collaterals. However, the significance of these changes during adenosine MPI in patients with left ventricular hypertrophy (LVH) on baseline electrocardiogram is less well understood.
Objective:
To evaluate whether ECG changes on adenosine MPI predict ischaemia in patients with LVH.
Methods:
We reviewed retrospectively 454 consecutive patients who had undergone adenosine MPI at our institution. The baseline electrocardiogram was reviewed to determine whether or not LVH was present. All patients were administered adenosine at 140 microg x kg x min for a total of 6 min and Tc-sestamibi was injected at 3 min into the protocol. None of the patients underwent any form of exercise during the stress test.
Results:
Of the 146 patients with LVH, 10 had stress ECG changes suggestive of ischaemia and 40 had evidence of ischaemia on MPI. Similarly, of the 308 patients without LVH, 43 had stress ECG changes suggestive of ischaemia and 68 had ischaemia on MPI. The sensitivity and specificity of stress ECG changes in predicting ischaemia on perfusion in patients with LVH were 12.5% and 95.3%, respectively, with a positive predictive value of 50% and a negative predictive value of 74.3%.
Conclusion:
ECG changes suggestive of ischaemia in patients with LVH are very specific for ischaemia on MPI, and their significance is similar to that in patients without LVH.
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