Objective
Myocardial perfusion scintigraphy (MPS) is a well-established diagnostic tool. The sensitivity and specificity of single photon emission computed tomography (SPECT) MPS to detect significant coronary lesion (coronary stenosis of more than 50%) were 86% and 74% respectively. A false negative result can be obtained in the SPECT MPS due to balanced multiple vessel disease. Other limitations in MPS are equivocal results due to attenuation artifacts, patient positional movement during the test, or uncorrectly applied technical analyses. Copeptin, the c-terminal part of the vasopressin prohormone, is released stochiometrically with arginin-vasopressin from the neurohypophysis and seems to reflect the individual endogenous stress level and also the mortality risk in coronary events. As endogenous stress is present already at the onset of coronary ischemia, copeptin appears to be able to detect coronary ischemia very early following symptom onset, even when cTn is still negative. The aim of this study was to examine the role of serum copeptin in evaluation of MPS.
Methods
62 consecutive patients undergone both SPECT MPS using 99mTc-sestamibi and transthoracic echocardiography were enrolled prospectively. Age, gender, height, weight, presence of cardiovascular risk factors were recorded. Exercise treadmill test (ETT) with modified Bruce protocol was used to induce coronary ischemia during MPS. While performing MPS, blood samples for serum copeptin level were drawn three times at pre-exercise, at the peak of ETT, and 6 hour after ETT respectively. The patients were enrolled into three groups according to MPS results (normal, equivocal and ischemia).
Methods
62 consecutive patients undergone both SPECT MPS using 99mTc-sestamibi and transthoracic echocardiography were enrolled prospectively. Age, gender, height, weight, presence of cardiovascular risk factors were recorded. Exercise treadmill test (ETT) with modified Bruce protocol was used to induce coronary ischemia during MPS. While performing MPS, blood samples for serum copeptin level were drawn three times at pre-exercise, at the peak of ETT, and 6 hour after ETT respectively. The patients were enrolled into three groups according to MPS results (normal, equivocal and ischemia).
Results
The study included 62 patients (23 with normal, 20 with equivocal, 19 with ischemia on MPS). The groups were statistically similar in respect to age, gender, cardiovascular risk factors, and resting blood pressure measurements (Table 1). LVEF, LA diameter and TDI Em/Am ratio of the groups were similar (p=0.061, 0.070, and 0.364 accordingly). Pre-exercise, peak-exercise and postexercise BNP and troponin I values were similar across the groups (p>0.05 for all comparisons). Serum copeptin values for preexercise and peak-exercise were similar among all groups (p=0.883 and 0.089). Postexercise copeptin value of the normal and equivocal groups were similar (p=0.661 z=-0.438) while that of the ischemia group was significantly higher than both normal group (p<0.001 z=-4.612) and equivocal group (p<0.001 z=-4.440).
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