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

Document Type : Original Article

Authors

1 Department of Cardiovascular Diseases, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

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

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

Abstract

Introduction: We aimed to investigate of effect of left bundle branch block (LBBB) on perfusion and functional parameters in dipyridamole Tc99m-MIBI gated myocardial perfusion SPECT which may be helpful in interpretation of myocardial perfusion imaging. Methods: We studied 70 patients with low pre-test probability of coronary artery disease in two groups:  35 patients with LBBB and  35 subjects with normal ECG. Both groups underwent two-day dipyridamole stress–rest Tc99m-MIBI GSPECT. Results: From 35 patients with LBBB, 6, 12, and 3 patients had reversible, fixed and partially reversible defects respectively. In 35 patients with LBBB, 8 (22.9%), 6(17.1%)  15( 42.9%) and 10 (28.6%) patients had perfusion defects in the apicoseptal,  mid-anterior segments , mid-anteroseptal and mid-inferoseptal segments respectively. There was significant difference in TID ratio between two groups:  LBBB group: 1.07±0.21 and control group: 0.96±0.14 (P=0.01). There was a significant difference in end systolic volume and ejection fraction between LBBB patients group and control group, while no significant difference was noticed in end-diastolic volume. Nineteen, 14 and 2 from 35 patients with LBBB had normal LV wall motion, paradoxical septal wall motion, and septal hypokinesia respectively. Conclusion: False positive septal, anterior and apicoseptal perfusion abnormalities are frequently seen on Tc99m-MIBI GSPECT, in patients with LBBB without CAD. Moreover reversible defects are frequently seen with Tc99m-MIBI. Even Tc99-MIBI and vasodilator stress do not increase diagnostic accuracy to clinically useful levels. Lower systolic performance and higher TID ratio could be seen in these patients.

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References

Inanir S, Caliskan B, Tokay S, Oktay A. QRS complex duration and dipyridamole gated SPECT findings in the left bundle branch block. Ann Nucl Med. 2008 Aug;22(7):565-70.
Pavlovic S, Sobic-Saranovic D, Djordjevic-Dikic A, Beleslin B, Stepanovic J, Artiko V, Giga V, Petrasinovic Z, Ostojic M, Vujisic-Tesic B, Obradovic V. Comparative utility of gated myocardial perfusion imaging and transthoracic coronary flow reserve for the assessment of coronary artery disease in patients with left bundle branch block. Nucl Med Commun. 2010 Apr;31(4):334-40.
Inanir S, Caymaz O, Okay T, Dede F, Oktay A, Deger M, Turgut Turoglu H. Tc-99m sestamibi gated SPECT in patients with left bundle branch block. Clin Nucl Med. 2001 Oct;26(10):840-6.
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.
Bavelaar-Croon CD, Wahba FF, Van Hecke MV, Atsma DE, Stokkel MP, Pauwels EK, Van der Wall EE. Perfusion and functional abnormalities outside the septal region in patients with left bundle branch block assessed with gated SPECT. Q J Nucl Med. 2001 Mar;45(1):108-14.
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.
Karavidas AI, Matsakas EP, Lazaros GA, Brestas PS, Avramidis DA, Zacharoulis AA, Fotiadis IN, Korres DA, Zacharoulis AA. Comparison of myocardial contrast echocardiography with SPECT in the evaluation of coronary artery disease in asymptomatic patients with LBBB. Int J Cardiol. 2006 Oct 10;112(3):334-40.
Tandoğan I, Yetkin E, Ileri M, Ortapamuk H, Yanik A, Cehreli S, Duru E. Diagnosis of coronary artery disease with Tl-201 SPECT in patients with left bundle branch block: importance of alternative interpretation approaches for left anterior descending coronary lesions. Angiology. 2001 Feb;52(2):103-8.
Candell-Riera J, Oller-Martínez G, Rosselló J, Pereztol-Valdés O, Castell-Conesa J, Aguadé-Bruix S, Soler-Peter M, Simó M, Santana-Boado C, García-Burillo A, Soler-Soler J. Standard provocative manoeuvres in patients with and without left bundle branch block studied with myocardial SPECT. Nucl Med Commun. 2001 Sep;22(9):1029-36.
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.
 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.
Ono S, Nohara R, Kambara H, Okuda K, Kawai C. Regional myocardial perfusion and glucose metabolism in experimental left bundle branch block. Circulation. 1992 Mar;85(3):1125-31.
Patel R, Bushnell DL, Wagner R, Stumbris R. Frequency of false-positive septal defects on adenosine/201T1 images in patients with left bundle branch block. Nucl Med Commun. 1995 Mar;16(3):137-9.
Larcos G, Gibbons RJ, Brown ML. Diagnostic accuracy of exercise thallium-201 single-photon emission computed tomography in patients with left bundle branch block. Am J Cardiol. 1991 Sep 15;68(8):756-60.
Fallahi B, Beiki D, Eftekhari M, Gilani KA, Fard-Esfahani A, Gholamrezanezhad A, Sharif AY, Ansari M, Saghari M. High accuracy of myocardial perfusion imaging in patients with left bundle branch block: comparison of four interpretation approaches. Hell J Nucl Med. 2009 May-Aug;12(2):132-7.
Iranian Journal of Nuclear Medicine
Volume 21, Issue 1 - Serial Number 39
Serial number: 39
June 2013
Pages 7-12

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