Diagnostic accuracy and feasibility of myocardial perfusion imaging in patients with end stage lung disease

Introduction: Coronary artery disease (CAD) is a common comorbidity in end stage lung disease (ELD), especially in chronic obstructive lung disease (COPD) and interstitial lung disease (ILD). Shortness of breath and angina are difficult to distinguish and non-invasive exercise testing for diagnosis of stable coronary artery disease is limited by functional impairment in patients with ELD. Myocardial perfusion imaging (MPI) is an established non-invasive tool for ischemia detection.
Objective: To assess the diagnostic value of MPI with single photon emission computed tomography (SPECT) in patients with ELD.
Methods: 109 patients (54 COPD, 55 ILD; 32% wo-men) were assessed retrospectively from 01/2012 to 05/2018 at the University of Munich. All patients underwent both MPI and coronary angiography (CAG).
Results: The mean age was 59±6 years. Mean values of pulmonary function tests were (% predicted): FVC of 50±16, FEV1 37±20, 6-min. walk distance of 245±133 m. Pulmonary hypertension (PH) was present in 41 patients (38%). 87% of patients required long term oxygen treatment. 18 patients (17%) had abnormal MPI. CAG ruled out an obstructive CAD in 98 patients (91%); revascularisation was needed in 10 (9%). Specificity and negative predictive value for MPI for obstructive CAD were: overall 88% [80-94] and 96% [91-98], ILD only 96% [86-99] and 90% [81-95], COPD only 80% [67-90] and 95% [90-97], when PH present 92% [79-98] and 100%. Only 3% of patients experienced severe regade-noson adverse-effects.
Conclusions: Our results suggest that MPI in patients with ELD is well-tolerated and has a high negative predictive value for obstructive CAD. This can help identify patients with ELD and obstructive CAD.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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