Original ArticleMyocardial perfusion imaging analysis in patients with regurgitant valvular heart disease
Introduction
Myocardial perfusion imaging (MPI) is frequently performed to diagnose new coronary artery disease (CAD) and to risk stratify patients with known CAD. MPI has been shown to have a reasonable sensitivity of 87%-89% and specificity 73%-75% for detection of CAD with either exercise or vasodilator stress. Myocardial perfusion imaging abnormalities are known to be present in patients without critical coronary stenosis but associated with other myocardial diseases and left ventricle dysfunction. In patients with significant mitral or aortic regurgitation (MR, AR), there are significant hemodynamic changes that result in left ventricular volume overload, eccentric cardiac hypertrophy with increased left ventricular chamber volumes with eventual progression to left ventricular dysfunction and failure.1,2 The literature regarding the diagnostic accuracy of MPI in patients with moderate to severe MR or AR is sparse.3
Section snippets
Study Design
Systematic review of the findings from patients that have MPI and CATH is performed as part of the clinical quality review program. During the time between January 1998 and January 2008 approximately 1,500 patient records were reviewed at the Harry S. Truman Memorial Veterans’ Hospital. Fifty-eight patients were identified from this group who also had echocardiography that demonstrated moderate to severe mitral valve or aortic valve regurgitation. Data from the medical record of these patients
Results
We identified 58 patients with at least moderate MR or AR by echocardiogram who underwent cardiac catheterization within 6 months of the MPI study (study group). The control group was formulated with 60 patients who did not have significant MR or AR on echocardiogram and who had both MPI and CATH, Table 1. Study group patients had the following types of valvular regurgitation: 42 had moderate MR, 2 had moderate-severe MR, 4 had severe MR, 5 had moderate AR, and 5 had moderate MR and moderate
Discussion
In this retrospective study of male veterans with mitral and aortic regurgitation there was decreased positive predictive value of MPI in identifying CAD when compared to patients without valvular heart disease (76% vs 90%). The ability of MPI in identifying critical CAD in the control group was similar to previous published studies.3 There was also a significant decrease in the left ventricle ejection fraction in the patients with regurgitant valve disease. In the study group, MR was most
Limitations
Our small retrospective study is comprised predominantly of older men. In women and younger men the findings of MPI may be different. Our study subjects had a reduced EF when compared to controls and may have had a higher proportion of primary myocardial pathologies that were the cause of the MPI abnormalities. Comparison of the left ventricle volumes in the two groups was not performed. We have not performed longitudinal follow-up to ascertain the clinical impact of the MPI abnormalities.
Conclusions
In men with moderate regurgitant valvular disease and cardiomyopathy, the specificity of MPI is decreased when compared to patients without valvular heart disease. Gated SPECT is reliable in determining systolic function in this population. Prior to cardiac valve surgery, current practice of definitive evaluation by coronary angiography appears justified.
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This report was supported with resources and the use of facilities at the Harry S. Truman Memorial Veterans’ Hospital.
VISN 15 Veterans Administration Research award to A. Chockalingam.