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Initial experience with regadenoson stress positron emission tomography in patients with left bundle branch block: Low prevalence of septal defects and high accuracy for obstructive coronary artery disease

  • Dane MeredithEmail author
  • Paul C. Cremer
  • Serge C. Harb
  • Bo Xu
  • Amgad Mentias
  • Wael A. Jaber
Original Article

Abstract

Background

Assessing for coronary artery disease (CAD) in patients with left bundle branch block (LBBB) is difficult with noninvasive cardiac imaging. Few studies report the prevalence of LBBB associated septal-apical perfusion defects using regadenoson stress on Positron Electron Tomography (PET) imaging.

Methods and Results

We identified 101 consecutive patients with baseline LBBB, and without known CAD, who underwent rest-stress regadenoson PET. Investigators have the ability to prospectively identify studies, whose quality is limited by LBBB artifact. With the infusion of regadenoson, resting to peak stress heart rate rose from a median of 78 to 93 BPM. Despite this, LBBB perfusion artifacts were not identified in any studies. 10 individuals had both regadenoson SPECT and PET within 1 year. 3 of the 10 SPECT studies had LBBB artifacts, all of which were not seen on subsequent PET. 21 patients with PET had subsequent coronary angiography. Of these, 9 PETs were without significant inducible ischemia, and angiogram was without flow-limiting disease. 3 PETs identified inducible ischemia, but did not have flow-limiting disease on angiogram. 9 PETs identified inducible ischemia and had flow-limiting disease on angiogram.

Conclusions

In patients with LBBB undergoing regadenoson PET stress imaging, artifactual septal perfusion defects are rare.

Keywords

Left bundle branch block positron emission tomography coronary artery disease regadenoson 

Abbreviations

CAD

Coronary artery disease

IRB

Institutional review board

LAD

Left anterior descending

LBBB

Left bundle branch block

LCx

Left circumflex

MPI

Myocardial perfusion imaging

PET

Positron emission tomography

Rb-82

Rubidium-82

RCA

Right coronary artery

SPECT

Single-photon emission computed tomography

Notes

Disclosure

Dane Meredith, Paul Cremer, Serge Harb, Bo Xu, Amgad Mentias, and Wael Jaber have no relationships relevant to the contents of this paper to disclose.

Supplementary material

12350_2019_1681_MOESM1_ESM.pptx (4.3 mb)
Supplementary material 1 (PPTX 4396 kb)

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Copyright information

© American Society of Nuclear Cardiology 2019

Authors and Affiliations

  • Dane Meredith
    • 1
    Email author
  • Paul C. Cremer
    • 1
  • Serge C. Harb
    • 1
  • Bo Xu
    • 1
  • Amgad Mentias
    • 2
  • Wael A. Jaber
    • 1
  1. 1.Department of Cardiovascular Imaging, Heart and Vascular InstituteCleveland ClinicClevelandUSA
  2. 2.Department of Cardiovascular MedicineUniversity of IowaIowa CityUSA

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