Abstract P273: Does Coronary Vessel Dominant System Dictate False Positive Results in Nuclear Stress Imaging?
Objective: We sought to investigate whether the coronary vessel dominance dictates the false positive results in nuclear stress imaging.
Background: Atherosclerotic coronary artery disease is the leading cause of morbidity and mortality in men and women in the United States. Myocardial perfusion imaging (MPI) has provided incremental diagnostic and prognostic information in evaluation of patients with suspected or known coronary artery disease. It has a sensitivity of 87% but specificity of 64%. Tissue attenuation secondary to diaphragm or breast have been documented as a cause of false positive tests. It is also believed that patients with a left dominant coronary system are more prone to have a false positive test, however there is no conclusive literature available supporting this.
Methods: A retrospective analysis was performed of all patients who underwent coronary angiography from January 2006 to December 2008, who had intermediate to high probability of ischemia as assessed by MPI. The location and the size of ischemia were documented. Patients were classified as either true positive (TP) or false positive (FP) based on presence of significant coronary stenosis (>50%) by angiography. Furthermore, coronary vessel dominance (right, left or mixed) was documented.
Results: A total of 991 patients were included in the analysis. 901 patients had a TP test (91%). As expected, females had a significantly higher FP rate compared to males (16.1% vs. 4.6%, p<0.05).The population was divided into three groups, right, left and co-dominant system: 855, 93 and 43 patients respectively. There was no difference in the FP rate between the right and co-dominant systems (8.1% vs. 7.5%, p=0.7). Patients with left dominant systems were noted to have higher rate of false positive (12.9%) however, this did not achieve statistical significance (p=0.1). When location of lesion was taken into consideration, the far majority (92%) of anterior wall FP cases were females, regardless of system dominance.
Conclusion: This is preliminary study supported previous study that female have a higher FP test on their MPI. Furthermore, patients with left dominant system are more prone for FP than either co dominant or right dominant system, especially in females.
- © 2011 American Heart Association, Inc.