title: Myocardial perfusion imaging does not adequately assess the risk of coronary artery disease in patients with atrial fibrillation.
abstract: OBJECTIVE
  The role of coronary artery disease (CAD) in atrial fibrillation (AF) is poorly investigated. This study investigated the value of myocardial perfusion single-photon emission computed tomography (SPECT) in the assessment of risk of CAD in patients with a history of AF.
  
  
  RESULTS
  Out of consecutive patients without previous coronary angiogram or history of CAD referred for SPECT, patients with a history of AF (n = 129) were compared with age- and gender-matched controls (n = 124). Primary endpoint was positive SPECT, i.e. unambiguous signs of ischaemia. There was no significant difference with regard to positive SPECT outcome between AF patients and controls (14 patients, 11% vs. 21 patients, 17%; P = 0.16). Coronary angiography (CAG) performed after SPECT demonstrated a higher yield of positive SPECT regarding significant CAD in control patients (10 out of 15 patients, 67%) than in AF patients (2 out of 13 patients, 15%; P = 0.006).
  
  
  CONCLUSIONS
  Positive SPECT outcome was similar in patients with AF and in controls. Nevertheless, in AF patients a positive SPECT outcome was less often related to significant CAD in those patients who subsequently underwent CAG. These results emphasize the need for new non-invasive techniques to adequately assess the risk of significant CAD in AF patients.
authors.affiliation: Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: Marcelle D
authors.initials: MD
authors.lastname: Smit
authors.forename: René A
authors.initials: RA
authors.lastname: Tio
authors.forename: Riemer H J A
authors.initials: RH
authors.lastname: Slart
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.forename: Isabelle C
authors.initials: IC
authors.lastname: Van Gelder
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016022:Case-Control Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000009:adverse effects*; D012039:Regional Blood Flow / Q000502:physiology; D015203:Reproducibility of Results; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000009:adverse effects*; D014655:Vascular Resistance / Q000502:physiology