Abstract
Background
The aim of this study was to assess the value of a myocardial perfusion single photon emission computed tomography (SPECT) reference file for patients with left bundle branch block (LBBB).
Methods and Results
Tl-201 stress-redistribution myocardial perfusion SPECT studies of patients with complete, permanent LBBB were reviewed retrospectively. To develop a reference database, 18 patients with a low likelihood of coronary artery disease (CAD) were selected. Left ventricular regional average and standard deviation (SD) values of the reference file images were calculated. The diagnostic performance was tested on perfusion images of 49 patients with LBBB, undergoing both scintigraphic and coronary angiographic evaluation, and was compared with a commercial quantitative analysis system using a general reference database. The LBBB reference file performed significantly better in detecting epicardial CAD than did the general reference database (receiver operating characteristic area under the curve 0.835 ± 0.06 vs 0.580 ± 0.08, p < .01). Disease localization also was improved significantly in the territory of the left anterior descending and of the right coronary arteries.
Conclusions
The use of a reference file of patients with LBBB and a low likelihood of CAD aids the detection and the localization of myocardial ischemia on Tl-201 myocardial SPECT images of this patient group.
Similar content being viewed by others
References
Klocke FJ, Baird MG, Bateman TM, Berman DS, Carabello BA, Cerqueira MD, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. American College of Cardiology Web Site 2003. Available at: http://www.acc.org/clinical/guidelines/ mi_fulltext.pdf. Accessed on October 10, 2005.
Julian DG, Bertrand ME, Hjalmarsson A, Fox K, Simoons ML, Ceremuzynski L, et al. Management of stable angina pectoris. Recommendations of the Task Force of the European Society of Cardiology. Eur Heart J 1997;18:394–413.
DePuey EG, Guertler-Krawczynska E, Robbins WL. Thallium-201 SPECT in coronary artery disease patients with left bundle-branch block. J Nucl Med 1988;29:1479–85.
Jazmati B, Sadaniantz A, Emaus SP, Heller GV. Exercise thallium- 201 imaging in complete left bundle branch block and the prevalence of septal perfusion defects. Am J Cardiol 1991;67:46–9.
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.
Matzer L, Kiat H, Friedman JD, van Train K, Maddahi J, Berman DS. A new approach to the assessment of tomographic thallium- 201 scintigraphy in patients with left bundle branch block. J Am Coll Cardiol 1991;17:1309–19.
Krishnan R, Lu J, Zhu Y, Dae MW, Botvinick EH. Myocardial perfusion scintigraphy in left bundle branch block: a perspective on the issue from image analysis in a clinical context. Am Heart J 1993;126:578–86.
Lebtahi NE, Stauffer JC, Delaloye AB. Left bundle branch block and coronary artery disease: accuracy of dipiridamole thallium-201 single-photon emission computed tomography in patients with exercise anteroseptal perfusion defects. J Nucl Cardiol 1997;4:266–73.
Candell-Riera J, Oiler-Martinez G, Rossello J, Pereztol-Valdes O, Castell-Conesa J, Aguade-Bruix S, et al. Standard provocative manoeuvres in patients with and without left bundle branch block studied with myocardial SPECT. Nucl Med Comm 2001;22:1029–36.
Tandogan I, Yetkin E, Ileri M, Ortapamuk H, Yanik A, Éehreli S, et al. 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;52:103–8.
Alexánderson E, Mannting F, Gömez-Martín D, Fermon S, Meave A. Technetium-99m-sestamibi SPECT myocardial perfusion imaging in patients with complete left bundle branch block. Arch Med Res 2004;35:150–6.
Feola M, Biggi A, Ribichini F, Camuzzini G, Uslenghi E. The diagnosis of coronary artery disease in hypertensive patients with chest pain and complete left bundle branch block. Utility of adenosine Tc-99m tetrofosmin SPECT. Clin Nucl Med 2002;27:510–5.
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.
Hasegawa S, Sakata Y, Ishikura F, Hirayama A, Kusuoka H, Nishimura T, et al. Mechanism for abnormal thallium-201 myocardial scintigraphy in patients with left bundle branch block in the absence of angiographic coronary artery disease. Ann Nucl Med 1999;13:253–9.
van TrainKF, Garcia EV, Cooke D, Areeda J. Quantitative analysis of SPECT myocardial perfusion. In: DePuey EG, Berman DS, Garcia EV, editors. Cardiac SPECT imaging. New York: Raven Press Ltd.; 1995; pp. 49–74.
Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983; 148:839–43.
Sugihara H, Tamaki N, Nozawa M, Ohmura T, Inamoto Y, Taniguchi Y, et al. Septal perfusion and wall thickening in patients with left bundle branch block assessed by technetium-99m-sestamibi gated tomography. J Nucl Med 1997;38:545–7.
Kasai T, DePuey EG, Shah AA. Decreased wall thickening in patients with left bundle branch block. J Nucl Cardiol 2004;11:32–7.
Bums RJ, Galligan L, Wright LM, Lawand S, 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.
Vernooy K, Verbeek XA, Peschar M, Crijns HJ, Arts T, Comelussen RN, et al. Left bundle branch block induces ventricular remodelling and functional septal hypoperfusion. Eur Heart J 2005;26:91–8.
Bavelaar-Croon CD, Wahba FF, van Hecke MV, Atsma DE, Stokkel MP, Pauwels EK, et al. Perfusion and functional abnormalities outside the septal region in patients with left bundle branch block assessed with gated SPECT. Q J Nucl Med 2001;45:108–14.
Sugiura M, Hiraoka K, Ohkawa S, Ueda K, Toku A. A clinicopathological study on 25 cases of complete left bundle branch block. Jpn Heart J 1979;20:163–76.
Peace RA, Staff RT, Gemell HG, McKiddie FI, Metcalfe MJ.Automatic detection of coronary artery disease in myocardial perfusion SPECT using image registration and voxel to voxel statistical comparisons. Nucl Med Commun 2002;23:785–94.
Verbeme HJ, Habraken JBA, van RoyenEA, Tiel-van Buul MMC, Piek JJ, van Eck-Smit BLF. Quantitative analysis of 99Tcm- sestamibi myocardial perfusion SPECT using a three-dimensional reference heart: a comparison with experienced observers. Nucl Med Commun 2001;22:155–63.
Sharir T, Germano G, Waechter PB, Kavanagh PB, Areeda JS, Gerlach J, et al. A new algorithm for the quantitation of myocardial perfusion SPECT. II: validation and diagnostic yield. J Nucl Med 2000;41:720–7.
Tauberg SG, Orie JE, Bartlett BE, Cottington EM, Flores AR.Usefulness of thallium-201 for distinction of ischemic from idiopathic dilated cardiomyopathy. Am J Cardiol 1993;71:674–80.
Wu YW, Yen RF, Chieng PU, Huang PJ. Tl-201 myocardial SPECT in differentiation of ischemic from nonischemic dilated cardiomyopathy in patients with left ventricular dysfunction. Am J Cardiol 2003;10:369–74.
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 of dobutamine imaging? J Am Coll Cardiol 1996;28:543–50.
Caner B, Rezaghi C, Uysal U, Tokgozoglu L, Kabakei G, Elahi N, et al. Dobutamine thallium-201 myocardial SPECT in patients with left bundle branch block and normal coronary arteries. J Nucl Med 1997;38:424–7.
Nozawa T, Sasayama S, Takabatake H, Wada O, Futatsuya R, Asanoi H, et al. Usefulness of thallium-201 scintigraphy during right ventricular pacing for detecting myocardial ischaemia with angiographically normal coronary arteries. Am J Cardiol 1987;59: 1222–3.
Hansen CL. The conundrum of left bundle branch block. J Nucl Cardiol 2004; 11:90–2.
Inanir S, Caymaz O, Okay T, Dede F, Oktay A, Deger M, et al. Tc-99m sestamibi gated SPECT in patients with left bundle branch block. Clin Nucl Med 2001;26:840–6.
Demir H, Erbay G, Kir KM, Omurlu K, Berk F, Aktolun C.Clinical validation of technetium-99m MIBI-gated single-photon emission computed tomography (SPECT) for avoiding false positive results in patients with left bundle-branch block: comparison with stress-rest nongated SPECT. Clin Cardiol 2003;26:182–7.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors thank Professor Mátyás Keltai MD and István Szilvási MD for valuable discussions. The authors also thank József Turák (Mediso Ltd., Budapest, Hungary) for providing technical information on the Interview image processing system.
Rights and permissions
About this article
Cite this article
Zupán, K., Kári, B., Fontos, G. et al. Thallium-201 myocardial SPECT in left bundle branch block: Diagnosis of myocardial ischemia with a disease-specific reference database. J Nucl Cardiol 13, 521–530 (2006). https://doi.org/10.1016/j.nuclcard.2006.03.006
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1016/j.nuclcard.2006.03.006