RESUMEN
Regadenoson Stress Echocardiography (RSE) can detect myocardial ischemia, and its diagnostic accuracy should be evaluated. We sought to investigate the agreement between RSE and gated-SPECT myocardial perfusion imaging (MPI) and appraise its diagnostic accuracy. Consecutive patients (n = 202) referred for non-invasive evaluation of myocardial ischemia, with (38.6%) or without a previous coronary artery disease (CAD) diagnosis, were enrolled. Both tests were performed simultaneously. Invasive coronary angiography (CA) is considered the gold standard. The mean age was 70.9 (9.8) years, and 59.9% were male. The prevalence of cardiovascular risk factors (arterial hypertension [81.7%], diabetes mellitus [37.6%], hypercholesterolemia [71.8%], and smoking [18.8%]) was high. Forty-four patients (21.8%) had a non-interpretable electrocardiogram, 15 (34.1%) of them were a result of ventricular paced-rhythm, while 29 (65.9%) were a result of advanced left ventricular branch block. The overall agreement between both diagnostic techniques was good: Gwet's AC1 0.66 (CI95% 0.55 to 0.76), and it was higher in patients without a previous CAD diagnosis: 0.76 (CI95% 0.65 to 0.87). In the biased sample (those who underwent CA), RSE and nuclear study sensitivity was 0.50 and 0.78 and specificity was 0.75 and 0.75, respectively. We noted a dramatic reduction in sensitivity for RSE after debiasing (debiased sensitivity of 0.16), and the negative predictive value was similar to the biased and debiased samples. RSE is in strong agreement with gated-SPECT MPI. However, its low sensitivity and negative predictive value preclude its use as a bedside test to detect myocardial ischemia.
Asunto(s)
Ecocardiografía de Estrés , Isquemia Miocárdica/diagnóstico por imagen , Imagen de Perfusión Miocárdica , Purinas , Pirazoles , Tomografía Computarizada de Emisión de Fotón Único , Vasodilatadores , Anciano , Técnicas de Imagen Sincronizada Cardíacas , Comorbilidad , Femenino , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/epidemiología , Isquemia Miocárdica/fisiopatología , Compuestos Organofosforados , Compuestos de Organotecnecio , Valor Predictivo de las Pruebas , Prevalencia , Radiofármacos , Reproducibilidad de los Resultados , Fumar/efectos adversos , Fumar/epidemiología , Tecnecio Tc 99m SestamibiAsunto(s)
Angina de Pecho/complicaciones , Infarto del Miocardio/complicaciones , Infarto del Miocardio/terapia , Función Ventricular Izquierda/fisiología , Anciano , Angioplastia Coronaria con Balón , Dobutamina , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Contracción Miocárdica , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/patología , Índice de Severidad de la Enfermedad , Terapia TrombolíticaRESUMEN
Tricuspid stenosis related to endocardial pacemaker leads is uncommon. We report the case of a patient with severe tricuspid stenosis documented 15 years after the implantation of a permanent DDD pacemaker for symptomatic congenital heart block. The atrial and ventricular leads both had a loop at the level of the tricuspid valve that may have caused endothelial damage and, eventually, tricuspid stenosis.
Asunto(s)
Marcapaso Artificial/efectos adversos , Estenosis de la Válvula Tricúspide/etiología , Adulto , Femenino , HumanosRESUMEN
La estenosis tricúspide relacionada con la presencia de un electrodo de marcapasos es poco frecuente. Describimos el caso de una paciente que presentaba una estenosis tricúspide severa diagnosticada 15 años tras implantarse un marcapasos intracavitario DDD. Ambos electrodos auricular y ventricular presentaban un bucle que se apoyaba sobre el plano valvular tricúspide (AU)
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