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[Detection of coronary disease before valve surgery. Contribution of myocardial scintigraphy with dipyridamole]
Insights
Myocardial scintigraphy with dipyridamole (MS-DP) shows low sensitivity for detecting coronary artery disease in valve disease patients. MS-DP is not recommended for guiding coronary arteriography before valve surgery.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiovascular Surgery
Background:
- Detecting coronary artery disease (CAD) before valve surgery is challenging without coronary arteriography.
- Myocardial scintigraphy with dipyridamole (MS-DP) is a non-invasive imaging technique.
Purpose of the Study:
- To evaluate the diagnostic accuracy of MS-DP in detecting CAD in patients undergoing valve surgery.
- To assess the utility of MS-DP in guiding decisions for coronary arteriography.
Main Methods:
- 34 consecutive patients with valve disease underwent both MS-DP and coronary arteriography.
- Coronary arteriography was indicated by angina or age criteria.
- CAD was defined by >70% stenosis on arteriography; MS-DP was positive for perfusion defects.
Main Results:
- Coronary disease was present in 38% of patients (13/34).
- MS-DP correctly identified CAD in 69% (sensitivity) and ruled it out in 95% (specificity).
- Positive MS-DP significantly increased the predictive value of angina for CAD from 52% to 90%.
Conclusions:
- MS-DP has high specificity but limited sensitivity for detecting CAD in this population.
- Relying solely on MS-DP results to decide on coronary arteriography before valve surgery is not advisable due to its low sensitivity.
Abstract:
The detection of coronary disease before valve surgery remains difficult in the absence of coronary arteriography. The contribution of myocardial scintigraphy with dipyridamole (MS-DP) was studied in 34 consecutive patients with valve disease (11 mitral and 23 aortic) with a mean age of 63 +/- 11 years having undergone coronary arteriography before valve surgery. Coronary arteriography was performed because of angina (21 cases) or age (women greater than 50, men greater than 40). Positive criteria of coronary disease were the presence of at least one frank and clearly visible fault of myocardial perfusion (MS-DP positive) and at least one stenosis of greater than 70 per cent by coronary arteriography. Coronary disease existed in 13 patients (38 per cent). Ten patients (29 per cent) had a positive MS-DP. The sensitivity and specificity of MS-DP in detecting coronary disease were 69 per cent and 95 per cent respectively. Its positive predictive value was 90 per cent. MS-DP was negative in all asymptomatic patients (19 per cent of them having coronary disease) and in 11 symptomatic patients (18 per cent of them having coronary disease). The low positive predictive value of angina (52 per cent) increased to 90 per cent when combined with a positive MS-DP. Because of relatively low sensitivity, basing indications for coronary arteriography before valve surgery on the results of MS-DP cannot be advised.