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Journal of Nuclear Cardiology

, Volume 4, Issue 4, pp 266–273 | Cite as

Left bundle branch block and coronary artery disease: Accuracy of dipyridamole thallium-201 single-photon emission computed tomography in patients with exercise anteroseptal perfusion defects

  • N. E. Lebtahi
  • J. C. Stauffer
  • A. Bischof Delaloye
Original Articles

Abstract

Background

Reduced septal or anteroseptal uptake of thallium-201 during exercise is frequently observed in patients with left bundle branch block (LBBB) even in the absence of left anterior descending (LAD) coronary artery disease. The purpose of this study was to evaluate prospectively the accuracy of dipyridamole201TI single-photon emission computed tomography (SPECT) in detecting LAD coronary artery disease in patients with LBBB and septal or anteroseptal perfusion defects on exercise201TI SPECT.

Methods and Results

Twelve consecutive patients (10 men and two women) with complete LBBB and septal or anteroseptal perfusion defects on exercise201TI SPECT underwent dipyridamole201TI SPECT. The delay between dipyridamole and exercise was 2 to 30 days. Coronary angiography was performed during this period in all patients. Six (50%) of 12 patients with exercise perfusion defects showed normal perfusion after dipyridamole; all had normal coronary angiograms. The remaining six patients also had positive results of dipyridamole studies, two with moderate and four with severe septal or anteroseptal perfusion defects. Coronary angiography showed significant (>50%) LAD coronary artery stenosis in three patients; three patients with severe septal or anteroseptal perfusion defects after dipyridamole had normal coronary angiograms. Neither the evaluation of apical involvement nor the presence of dilated ventricles, decreased left ventricular ejection fraction, or wall motion abnormalities could help to identify (or explain) false-positive results.

Conclusion

This study confirms that dipyridamole is more accurate than exercise in excluding LAD coronary artery disease. However, there are still false-positive results and the severity of the septal or anteroseptal perfusion defect does not add additional information to identify LAD coronary artery disease. Coronary angiography is thus necessary for positive dipyridamole study results to identify coronary artery disease as a major prognostic factor in patients with LBBB.

Key Words

left bundle branch block dipyridamole thallium-201 single-photon emission computed tomography coronary artery disease 

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References

  1. 1.
    Mc Gowan LR, Welch TG, Zaret BL, Bryson AL, Martin ND, Flamm MD. Noninvasive myocardial imaging with potassium-43 and rubidium-81 in patients with left bundle branch block. Am J Cardiol 1976;38:422–8.CrossRefGoogle Scholar
  2. 2.
    Hirzel HO, Senn M, Nuesch K, Buettner C, Pfeiffer A, Hess OM, et al. Thallium-201 scintigraphy in complete left bundle branch block. Am J Cardiol 1984;53:764–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Huerta EM, Rodriguez Padial L, Castro Beiras JM, Illera JP, Asin Cardiel E. Thallium-201 scintigraphy in patients having complete left bundle branch block with normal coronary arteries. Int J Cardiol 1987;16:43–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Rothbart MR, Beller GA, Watson DD, Nygaard TW, Gibson RS. Diagnostic accuracy and prognostic significance of quantitative thallium-201 scintigraphy in patients with left bundle branch block. Am J Noninvas Cardiol 1987;1:197–205.Google Scholar
  5. 5.
    DePuey EJ, Guertler-Krawcynska E, Robbins WL, Thallium-201 SPECT in coronary artery disease patients with left bundle branch block. J Nucl Med 1988;29:1479–85.PubMedGoogle Scholar
  6. 6.
    Burns RJ, Galligan L, Wright LM, Lawand L, Burke RJ, Gladstone PJ. Improved specificity of myocardial thallium-201 single-photon emission computed tomography in patients with left bundle branch block by dipyridamole. Am J Cardiol 1991;68:504–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Matzer L, Kiat H, Friedman JD, Van Train K, Maddahi J, Berman DS. A new approach to the assement of tomographic thallium-201 scintigraphy in patients with left bundle branch block. J Am Coll Cardiol 1991;17:1309–17.PubMedGoogle Scholar
  8. 8.
    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;68:756–60.PubMedCrossRefGoogle Scholar
  9. 9.
    La Canna G, Giubbini R, Metra M, Arosio G, Curnis A, Cicogna R, et al. Assessment of myocardial perfusion with thallium-201 scintigraphy in exercise-induced left bundle branch block: diagnostic value and clinical significance. Eur Heart J 1992;13:942–6.PubMedGoogle Scholar
  10. 10.
    Delonca J, Camenzid 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; 123:1201–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Ebersole DG, Heironimus J, Toney MO, Billingsley J. Comparison of exercise and adenosine technetium-99m sestamibi myocardial scintigraphy for diagnosis of coronary artery disease in patients with left bundle branch block. Am J Cardiol 1993;71:450–3.PubMedCrossRefGoogle Scholar
  12. 12.
    O'Keefe JH, Bateman TM, Barnhart CS. Adenosine thallium-201 is superior to exercise thallium-201 for detecting coronary artery disease in patients with left bundle branch block. J Am Coll Cardiol 1993;21:1332–8.PubMedGoogle Scholar
  13. 13.
    Vaduganathan P, Zuo-Xiang HE, 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;28: 543–50.PubMedCrossRefGoogle Scholar
  14. 14.
    Morais J, Soucy JP, Sestier F, Lamoureux F, Lamoureux J, Danais S. Dipyridamole testing compared to exercise stress for thallium-201 imaging in patients with left bundle branch block. Can J Cardiol 1990;1:5–8.Google Scholar
  15. 15.
    Jukema JW, Van der Wall EE, Van der Vis-Melsen MJE, Kruyswijk HH, Bruschke AVG. Dipyridamole thallium-201 scintigraphy for improved detection of left anterior descending coronary artery stenosis in patients with left bundle branch block. Eur Heart J 1993;14:53–6.PubMedGoogle Scholar
  16. 16.
    Rockett JF, Wood WC, Moinuddin M, Loveless V, Parrish B. Intravenous dipyridamole thallium-201 SPECT imaging in patients with left bundle branch block. Clin Nucl Med 1990;15:401–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Larcos G, Brown MI, Gibbons RJ. Role of dipyridamole thallium-201 imaging in left bundle branch block. Am J Cardiol 1991;68: 1097–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Patel R, Bushnell DL, Wagner R, Stumbris R. Frequency of false positive septal defects on adenosine/201TI images in patients with left bundle branch block. Nucl Med Commun 1995;16:137–9.PubMedGoogle Scholar
  19. 19.
    Pope DL, Parker DL, Gustafson DE, Clayton PD. Dynamic search algorithms in left ventricular border recognition and analysis of coronary arteries. Comp Cardiol 1984;4:71–5.Google Scholar
  20. 20.
    Hodge J, Mattera J, Fetterman R, Williams B, Wackers FJ. False positive TL-201 defects in left bundle branch block: relationship to left ventricular dilatation. J Am Coll Cardiol 1987;9:137A.Google Scholar
  21. 21.
    Altehoefer C, Vom Dahl J, Kleinhans E, Uebis R, Hanrath P, Buell U.99mTc-methoxyisobutylisonitrile stress/rest SPECT in patients with constant complete left bundle branch block. Nucl Med Commun 1993;14:30–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Knapp WH, Bentrup A, Schmidt U, Ohlmeier H. Myocardial scintigraphy with thallium-201 and technetium-99m-hexakis-methoxyisobutilisonitrile in left bundle branch block: a study in patients with and without coronary artery disease. Eur J Nucl Med 1993;20:219–24.PubMedGoogle Scholar
  23. 23.
    Grines CL, Bashore TM, Boudoulas H, Olson S, Shafer P, Wooley CF. Functional abnormalities in isolated left bundle branch block: the effect of interventricular asynchrony. Circulation 1989;79:845–53.PubMedGoogle Scholar
  24. 24.
    Ono S, Nohara R, Kambara H, Okuda K, Kawai C. Regional myocardial perfusion and glucose metabolism in experimental left bundle branch block. Circulation 1992;85:1125–31.PubMedGoogle Scholar
  25. 25.
    Campeau RJ, Garcia OM, Colon R, Agusala M, Correa OA. False positive Tc-99m sestamibi SPECT in a patient with left bundle branch block. Clin Nucl Med 1993;18:40–2.PubMedCrossRefGoogle Scholar
  26. 26.
    Altehoefer C, Vom Dahl J, Bull U. Falsch-positiver Befund in der99mTc-MIBI SPECT bei Linksschenkelblock und angiographisch ausgeschlossener KHK. Nucl Med 1994;33:46–8.Google Scholar
  27. 27.
    Iskandrian AS, Verani MS. Nuclear cardiac imaging: principles and applications. Philadelphia: FA Davis, 1996:114–7.Google Scholar
  28. 28.
    Tamaki N, Yoshiharu Y, Mukai T, Kodama S, Kadota K, Kambara H, et al. Stress thallium-201 transaxial emission computed tomography: quantitative versus qualitative analysis for evaluation of coronary artery disease. J Am Coll Cardiol 1984;4:1213–21.PubMedGoogle Scholar
  29. 29.
    DePasquale EE, Nody AC, DePuey EG, Garcia EV, Pilcher G, Bredlean C, et al. Quantitative rotational thallium-201 tomography for identifying and localizing coronary artery disease. Circulation 1988;77:316–27.PubMedGoogle Scholar
  30. 30.
    Mahmarian JJ, Boyce T, Goldberg RK, Cocanougher MK, Roberts R, Verani MS. Quantitative exercise thallium-201 single photon emission computed tomography for the enhanced diagnosis of ischemic heart disease. J Am Coll Cardiol 1990;15:318–29.PubMedCrossRefGoogle Scholar
  31. 31.
    Braat SH, Brugada P, Bar FW, Gorgels APM, Wellens HJJ. Thallium-201 exercise scintigraphy and left bundle branch block. Am J Cardiol 1985;55:224–6.PubMedCrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 1997

Authors and Affiliations

  • N. E. Lebtahi
    • 1
  • J. C. Stauffer
    • 1
  • A. Bischof Delaloye
    • 1
  1. 1.Divisions of Nuclear Medicine and CardiologyUniversity HospitalLausanneSwitzerland

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