Gated 99mTc-MIBI myocardial perfusion SPECT in patients with right bundle branch block but without evidence of coronary artery disease

Document Type: Original Article


1 Nuclear Medicine Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Cardiovascular, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

3 Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran


Introduction: We aimed to investigate the effect of right bundle branch block (RBBB) on perfusion and functional parameters in dipyridamole stress/rest Tc99m-MIBI gated myocardial perfusion SPECT (GSPECT) which may be helpful in interpretation of myocardial perfusion imaging. Methods: We studied 73 patients with low pre-test likelihood of coronary artery disease in two groups:  38 patients with RBBB and 35 subjects with normal ECG. Both groups underwent two-day dipyridamole stress–rest Tc99m-MIBI GSPECT. Two groups were matched. There was no significant difference in sex and age variable between two groups. Results: Visual calculated SSS and SRS in all patients were between 0 and 3. Regarding the prone images, diaphragmatic attenuation and breast attenuation, all patients GSPECT findings were within normal limits. There was no significant difference in TID ratio between two groups:  RBBB group: TID ratio= 1.02±0.16 and control group: TID ratio= 0.96±0.14 (P=0.09). There was no significant difference in left ventricular end-systolic volume, end-diastolic volume, ejection fraction, summed stress and rest motion & thickening scores between RBB patients group and control group. No regional LV wall motion abnormality was noticed in any patient in either group. Conclusion: High normality rate of the LV myocardial perfusion and functional indices in the presence of RBBB was noticed in gated Dipyridamole stress/rest Tc-99m sestamibi myocardial perfusion SPECT.  No remarkable false positive perfusion findings or abnormal LV functional indices acquired by GSPECT in this group of patients.


Main Subjects

Dabbagh Kakhki VR, Zakavi SR, Sadeghi R, Emadzadeh MR, Vejdani A. Normal values of left ventricular functional indices in gated 99mTc-MIBI myocardial perfusion SPECT. Iran J Nucl Med. 2008;16(1): 14-9.

Paredes E, Candell-Riera J, Oller-Martínez G, de León G, Aguadé-Bruix S, Castell-Conesa J.Myocardial perfusion SPECT in right bundle branch block and left anterior hemiblock. Rev Esp Cardiol. 2004 Nov;57(11):1117-20.

Küçük NO, Arican P, Ibiş E, Aras G, Berkalp B, Oral D, Kir KM. False-positive results obtained with stress myocardial SPECT in patients with right bundle branch block. Clin Nucl Med. 2000 Aug;25(8):585-7.

Shih WJ, Berk MR, Mills BJ. Reversible thallium-201 perfusion defects of the septal and inferoapical segments in a patient with incomplete right bundle branch block and normal coronary angiogram. J Nucl Med. 1992 Aug;33(8):1556-7.

Inanir S, Dede F, Caliskan B, Erdil TY, Tokay S, Oktay A. Assessment of right and left ventricular perfusion in patients with right bundle branch block. Arch Med Res. 2006 Jan;37(1):58-64.

Wackers FJ. Myocardial perfusion defects in left bundle branch block: true or false? Fact or artifact? J Nucl Cardiol. 1997 Nov-Dec;4(6):550-2.

Vaduganathan P, He ZX, Raghavan C, Mahmarian JJ, Verani MS. Detection of left anterior descending coronary artery stenosis in patients with left bundle branch block: exercise, adenosine or dobutamine imaging? J Am Coll Cardiol. 1996 Sep;28(3):543-50.

De Bondt P, De Sutter J, Wiele CV, Montag I, Dierckx RA. Myocardial perfusion, wall motion and wall thickening in patients with left and right bundle branch block without prior infarction [abstract]. J Nucl cardiol. 2001;8(1):S89.

Delonca J, Camenzind E, Meier B, Righetti A. Limits of thallium-201 exercise scintigraphy to detect coronary disease in patients with complete and permanent bundle branch block: a review of 134 cases. Am Heart J. 1992 May;123(5):1201-7.

Tawarahara K, Kurata C, Taguchi T, Kobayashi A, Yamazaki N. Exercise testing and thallium-201 emission computed tomography in patients with intraventricular conduction disturbances. Am J Cardiol. 1992 Jan 1;69(1):97-102.

Mirvis DM, Goldberger AL. Electrocardiography. In: Braunwald E, Zipes DP, Lippy P, eds. Heart Disease. A Textbook of Cardiovascular Medicine, 6th ed. Philadelphia: W.B. Saunders; 2001. p. 82-128.

Higgins JP, Williams G, Nagel JS, Higgins JA. Left bundle-branch block artifact on single photon emission computed tomography with technetium Tc 99m (Tc-99m) agents: mechanisms and a method to decrease false-positive interpretations. Am Heart J. 2006 Oct;152(4):619-26.

Hayat SA, Dwivedi G, Jacobsen A, Lim TK, Kinsey C, Senior R. Effects of left bundle-branch block on cardiac structure, function, perfusion, and perfusion reserve: implications for myocardial contrast echocardiography versus radionuclide perfusion imaging for the detection of coronary artery disease. Circulation. 2008 Apr 8;117(14):1832-41.

Danesh-Sani SH, Zakavi SR, Sadeghi R, Fatemi M, Torabian-Kakhki M, Dabbagh kakhki VR. Gated myocardial perfusion SPECT in patients with left bundle block but having low probability of coronary artery disease; as compared to the patients with normal electrocardiogram. Iran J Nucl Med. 2013:21(1):7-12.

Javadi H, Jallalat S, Semnani S, Mogharrabi M, Nabipour I, Abbaszadeh M, Assadi M.  False-positive defects on exercise 99mTc-sestamibi SPECT imaging, but not on dipyridamole 99mTc-sestamibi SPECT imaging, in a patient with right bundle branch block (RBBB). Nucl Med Rev Cent East Eur. 2013;16(1):45-8.