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Research for coronary artery disease in patients with left bundle branch block: a new paradigm for coronary CT angiography multidetector row by anatomical and perfusion evaluation

Abstract

Patients with left bundle branch block (LBBB) whose etiology is coronary artery disease (CAD) have impaired their diagnostic investigation because of "interference" that this block offers to functional tests such as exercise testing and myocardial perfusion scintigraphy, and usually the cineangiocoronariography is requested to confirm the diagnosis of CAD in these patients.Therefore, with the use of coronary multi-detector tomography (MDCT), we propose the functional and anatomical evaluation in the same exam. Thus, patients under investigation for CAD and patients with LBBB, according to electrocardiographic criteria, will come from nuclear medicine sector at the Heart Institute, (INCOR) having performed the myocardial perfusion scintigraphy with pharmacological stress, and later sent to cardiovascular tomography sector at INCOR to perform the calcium score, coronary angiography and myocardial perfusion with dipyridamole. The coronary stenoses and perfusion defects on MDCT will be compared with perfusion defects in myocardial perfusion scintigraphy as well as the findings of coronary angiography. Therefore, coronary angiography could be fundamental in reducing costs, in evaluation of possible inconclusive examinations of myocardial scintigraphy, in the reduction of radiation emitted by complementary methods such as scintigraphy and coronary angiography and avoiding unnecessary invasive procedures and higher risks. (AU)

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