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Ischemic Cardiopathy. Perfusion Scintigraphy vs Coronary Angiography. 1997-1998

 Quesada Sánchez Lisandra; Borrego López Chávez Martha; Hechavarría Figueras Cesar.

Faculty of Medical Sciences of Granma." Celia Sánchez Manduley".
Manzanillo. Cuba.

Introduction
Objectives
Materials and Methods
Results
Discussion
Conclusions

Introduction:  The Cardiology is one of the medical specialties with bigger number of auxilliary diagnostic methods and the coronary illness is the heart pathology that most uses them along its natural history. The nuclear cardiology is already a super medical specialty that carries out an objective valuation of the function and perfusion regional miocardic facilitating the diagnosis of the ischemia and miocardic necrosis , demonstrating the quantity of the viable fabric, besides allowing to stratify each patient's individual risk. This investigation is highly expensive for its technology, equipment and for the radiomedicine, however it should not be absolute since its use situations exist in the studies of positive perfusion and lesions of the coronary tree are not informed (example: miocardiopathy, heart tumors, complete blockades of branches, aortic stenosis, illness of small glasses, etc.).

In the period of 1988-97 3261 revenues took place in the unit of coronary intensive surveillance; 38.1% of these patients were among the 40-59 year-old ages, stage where the man surrenders the biggest tributes to the society, the ischemic cardiopathy and the miocardial infarct come to truncate this period of life for what is justified the use of methods that, although expensive and invading, are used in the daily practice to diagnose, to evaluate and to predict the risk of the coronary illness. This motivates to carry out an evaluation of the agreement between both methods.

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Objectives:

General.

  1. To evaluate the agreement between the results of the perfusion scintigraphy and the coronary angiography in the patients with ischemic cardiopathy. Educational Surgical Clinical Hospital Saturnino Lora. January 1997 - June 1998.

Specific.

  1. Identify the association of the biological variables and the clinical diagnosis with the results of the perfusion scintigraphy and the coronary angiography.
  2. To relate the results of the electrocardiogram and the test of effort with the methods diagnoses in study.

To determine the presence of signs of severity of the ischemic cardiopathy according to both methods.

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Materials and Methods:

Comparative method.

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Results:

  1. Perfusión Scintigraphy.
  2. Positive: When some or more reception defects appeared in the stres images.
    Negative: reception defects didn't exist.

  3. Corony Angiography
  4. Positive: it was visualized in the radiological movie an stenosis image or attributable obstruction to ateroma badges independently of their magnitude and morphology.
    Negative: flat glasses were visualized and of caliber it standardizes and appropriate according to anatomical segment.

  5. Outlying electrocardiogram.
  6. Abnormal: When they were specific alterations or non specific of ischemic cardiopathy.

  7. It proves of effort.
  8. Positive: When they presented electric clinical alterations and/or included in the positive approaches suggested by RC Schlant (Schlant RC, Blomovist CG, Brandenburg RO., et to the one. Guidlines for exercice testing to report of the American College of Cardiology / American Heart Association Task Forced on assessment of cardiovascular procedures (sub-committe on exercice testing) JAm Coll Cardiol 1983; 8: 725-38).

  9. Signs of severity for coronary angiography: Lesion >= 50% of the trunk of the left coronary artery (CI). Lesion >= 75% of the previous descending artery (he/she GIVES), circumflex (CX) and/or right coronary artery (CD) in anyone of the segments; diffuse ateromatosis; illness of three glasses for presence of stenosis of the trunk of the CI with dominant left pattern, or the lesion of: he/she GIVES, CX and CD.

Signs of severity scintigraphy: Extension of the ischemia (activity of similar defect to the bottom); localization of the ischemia in previous face; late redistribution, lung reception, slow clearing of the talio; ischemic dilation of the left ventricle post-effort.

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Discussion: We observe according to groups of ages and sexes that the scintigraphy studies were positive in 58 patients (96.7%) and the coronary angiography showed 43 individuals of positive studies (71.7%). In the patients among 45-55 years the positive prevalence appears for the masculine sex. Of the patients with abnormal electrocardiogram 79.2% (38) they presented both positive studies, although the agreement was bad (coefficient of Kappa=0.28). Nevertheless direct relationship exists between the electric alterations and the coronary lesions. The use of tests of effort can demonstrate miocardial ischemia. In those individuals that presented a positive test of effort (49 for 81.7%), 81.6% (40) they presented perfusion scintigraphy and positive coronary angiography and in 9 cases results positive scintigraphy were shown in absence of coronary lesions demonstrated by the coronariy angiography (coefficient Kappa indefinite, bad agreement).

On the other hand the perfusión and the coronary angiography have been used in the diagnosis of the illness of three glasses. Of 43 patients with positive coronary angiography in 13 of them (30.2%) the diagnosis of the illness of 3 glasses was made. In 21 cases (48.9%) their existence was discarded by both methods. The coefficient of Kappa (0.60) it showed a good agreement for the diagnosis of this illness. In our series 40% (24 patients) presented severe coronary illness for nuclear studies and 33.3% (20 patients) for coronariography . In 20 patients (33.3%) both studies coincidex to diagnose a severe illness and 6.7% of the cases only presented a severe ischemic cardiopathy diagnosed by perfusion scintigraphy. Both studies coincided in pointing out absence of signs of severity in 36 patients (60%). A coefficient of Kappa of 0.8 was obtained.

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Conclusions:

  1. The perfusión scintigraphy with T1201 presented a bigger positivety percentage in connection with the coronary angiography and these results prevailed in patient masculine bigger than 45 years with independence of the clinical diagnosis (with heart infarct or not).
  2. The presence of an abnormal electrocardiogram and a positive test of effort you accompanies of a high percentage of scintigraphy studies and positive coronary angioigraphy.
  3. Both methods turned out to be concordant when evaluating the severity of the lesions in the coronary illness and the positive diagnosis of the illness of 3 glasses.

It is recommended to use early the perfusion scintigraphy and the coronary angiography in patient with sharp miocardial infarct to facilitate an appropriate behavior diagnosis and therapy.

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Questions, contributions and commentaries to the Authors: send an e-mail message (up to 15 lines, without attachments) to image-pcvc@pcvc.sminter.com.ar , written either in English, Spanish, or Portuguese.


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Bioengineering
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Update
Nov/11/1999


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