Comparison of myocardial contrast echocardiography with SPECT in the evaluation of coronary artery disease in asymptomatic patients with LBBB

Abstract Objective The non-invasive assessment of coronary artery disease (CAD) in patients with left bundle branch block (LBBB) is troublesome. In this study, we investigated the diagnostic accuracy of myocardial contrast echocardiography (MCE) with adenosine to detect CAD in asymptomatic patients with LBBB, and we compared it with single photon emission computed tomography (SPECT) with adenosine. Methods Forty-seven patients with LBBB, and no previously documented CAD, initially underwent SPECT imaging and 1–3 days later MCE. Coronary arteriography was performed within 1 week from the latter procedure. Results The overall sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and κ index of concordance of SPECT were 73%, 72%, 44%, 90%, 72%, and 0.37±0.13, respectively, whereas those of MCE were 91%, 92%, 77%, 97%, 92%, and 0.77±0.1, respectively ( p Conclusions MCE with adenosine has a higher global diagnostic accuracy compared to SPECT for the detection of CAD in patients with LBBB, mainly due to the poor specificity of SPECT concerning perfusion defects detection in the left anterior descending artery territory.