Impact of hypertension on the accuracy of exercise stress myocardial perfusion imaging for the diagnosis of coronary artery disease

Abstract

Aim-To compare the accuracy of exercise stress myocardial perfusion single photon emission computed tomography (SPECT) imaging for the diagnosis of coronary artery disease in patients with and without hypertension. Methods-A symptom limited bicycle exercise stress test in conjunction with 99m technetium sestamibi or tetrofosmin SPECT imaging was performed in 332 patients (mean (SD) age, 57 (10) years; 257 men, 75 women) without previous myocardial infarction who underwent coronary angiography. Of these, 137 (41%) had hypertension. Rest SPECT images were acquired 24 hours after the stress test. An abnormal scan was defined as one with reversible or fixed perfusion defects. Results-In hypertensive patients, myocardial perfusion abnormalities were detected in 79 of 102 patients with significant coronary artery disease and in nine of 35 patients without. In normotensive patients, myocardial perfusion abnormalities were detected in 104 of 138 patients with significant coronary artery disease and in 16 of 57 patients without. There were no diVerences between normotensive and hypertensive patients in sensitivity (77% (95% confidence interval (CI) 69% to 86%) v 75% (95% CI 68% to 83%)), specificity (74% (95% CI 60% to 89%) v 72% (95% CI 60% to 84%)), and accuracy (77% (95% CI 70% to 84%) v 74% (95% CI 68% to 80%)) of exercise SPECT for diagnosing coronary artery disease. The accuracy of SPECT was greater than electrocardiography, both in hypertensive patients (p = 0.005) and in normotensive patients (p = 0.0001). For the detection of coronary artery disease in individual vessels, sensitivity was 58% (95% CI 51% to 65%) v 57% (95% CI 51% to 64%), specificity was 86% (95% CI 82% to 90%) v 85% (95% CI 81% to 89%), and accuracy was 74% (95% CI 70% to 78%) v 74% (95% CI 70% to 78%) in patients with and without hypertension (NS). Conclusions-In the usual clinical setting, the value of exercise myocardial perfusion scintigraphy for diagnosing coronary artery disease is not degraded by the presence of hypertension. (Heart 2001;85:655-661)

Early Detection of Coronary Artery Flow and Myocardial Perfusion Impairment in Hypertensive Patients Evidenced by Myocardial Blush Grade (MBG) and Thrombolysis in Myocardial Infarction (TIMI) Frame Count (TFC)

“…In fact, in accordance with the results obtained in the present study, perfusion abnormalities have been described in asymptomatic patients with systemic hypertension (30). The accuracy of myocardial perfusion scintigraphy in the detection of significant coronary artery disease has been reported to be in the range of 85-98% (31), but the issue of whether abnormal scan findings represent true perfusion changes or may be interpreted as false-positive remains controversial in nuclear cardiology.…”

ACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Imaging—Executive Summary

“…In these patients, stress nuclear techniques have similar diagnostic sensitivity and specificity to those observed in patients without LVH. The diagnostic value of myocardial perfusion SPECT is not generally degraded by the presence of hypertension without evidence of LVH, 33 although an increased frequency of false-positive studies has been reported in athletes. 34 Similarly, although the number of reports is small, the prognostic value of myocardial perfusion SPECT in patients with LVH appears to be equal to that observed in patients without LVH.…”

High probability of disease in angina pectoris patients: Is clinical estimation reliable?

“…Both left ventricular hypertrophy (more than 75% of our study population had a history of hypertension) and microvascular disease may be associated with perfusion abnormalities in the presence of normal coronary arteries (21,30,31). The precise impact of these confounders remains unknown; however, hypertension does not degrade the diagnostic value of MPS for diagnosing coronary artery disease (32), and none of the factors can explain the high rate of insignificant angiographic disease in these patients. Also possible are differences in practice and assessment of symptoms.…”