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 SestamibiRESUMEN
Se presenta el caso de una paciente con feocromocitoma de la glándula suprarrenal izquierda con las manifestaciones clínicas características. Se hace una breve revisión de la literatura, se señalan fundamentalmente algunos aspectos clínicos y métodos actuales de diagnósticos
Asunto(s)
Anciano , Femenino , INFORME DE CASO , Feocromocitoma/diagnóstico , Neoplasias de las Glándulas Suprarrenales/diagnósticoRESUMEN
Se presenta el caso de una paciente con feocromocitoma de la glándula suprarrenal izquierda con las manifestaciones clínicas características. Se hace una breve revisión de la literatura, se señalan fundamentalmente algunos aspectos clínicos y métodos actuales de diagnósticos