The importance of coronary angiography for ischemic sign confirmationdetected by myocardial perfusion scintigraphy

* Correspondence: drnurdan@yahoo.com To the Editor, We have read with interest the article titled “Asymmetric dimethylarginine is not a good predictor of ischemia using myocardial perfusion scintigraphy” published in the latest issue of the Turkish Journal of Medical Science, by Erkan et al. (1). We would like to point out some issues related to this article. Erkan et al. (1) reported that high asymmetric dimethylarginine (ADMA) levels are independently associated with ischemia, but the diagnostic accuracy was defined as weak. Several studies have shown that high ADMA levels cause atherosclerosis and play an important role in the pathogenesis of coronary artery disease (CAD). These studies were usually performed with patients with a diagnosis of CAD determined by coronary angiography (CAG) or known CAD (2,3). We believe that detection of ischemia with MPS in the study by Erkan et al., should be confirmed by CAG; moreover, if the ADMA levels were studied on CAG positive patients, that would be a more objective approach. Although MPS is a reliable and noninvasive tool for the diagnosis of CAD, especially when methods such as attenuation correction or prone imaging in MPS are not used, it is known that the false positive rate should be taken into account (4,5). Therefore, clinical use of ADMA levels and MPS provides more meaningful results in predicting CAD, with confirmation of ischemia by CAG. Finally, the study by Erkan et al. (1) is a preliminary work to show the relationship between myocardial perfusion imaging and ADMA levels. In order to become a more meaningful contribution, we believe that the MPS findings are to be confirmed by CAG in future studies. Received: 13.07.2015 Accepted/Published Online: 01.12.2015 Final Version: 23.06.2016 Letter to the Editor