SIGNIFICANCE OF PERFUSION DEFECTS ON DIPYRIDAMOLE THALLIUM CARDIAC SPECT IN PATIENTS WITH LEFT BUNDLE BRANCH BLOCK
AbstractBackground: Left Bundle Branch Block (LBBB) is a known cause of false positive results inmyocardial perfusion studies. We aimed at investigation of correlation between degree of severityof perfusion defect on cardiac Single Photon Emission Computed Tomography (SPECT) andpresence of coronary artery disease on angiography in patients with LBBB. Study Design: Thiswas an analytical study and was carried out at Department of Nuclear Cardiology and Departmentof Cardiac Catheterisation of Punjab Institute of Cardiology, Lahore from January 2007 to April2007. Methods: In this study patients having LBBB without known coronary artery disease(CAD) referred for myocardial perfusion studies to the Nuclear Cardiology Department fromoutpatient, indoor and emergency departments were included. Thallium201 stress/rest SinglePhoton Emission Tomography (SPECT) acquisition scanning was performed. The myocardialperfusion pattern was classified as normal, fixed defect and reversible defect. Coronaryangiography was used to confirm CAD only in patients with abnormal scan. Results: Thirtyconsecutive patients having LBBB were studied. All patients underwent myocardial perfusionimaging using dipyridamole pharmacologic stress. Fourteen patients (47%) revealed normalThallium201 uptake and distribution at the septum. Reversible defects were noted in 13 (43%)patients. Fixed defects were noted in 3 (10%) patients. Among four patients with mild perfusiondefects only 1 (25%) had significant coronary artery disease. In patients with moderate perfusiondefects, coronary angiogram was positive for significant coronary artery disease in 1 (33%)patient. In six patients having severe perfusion defects significant coronary artery disease wasnoted in 5 (83%) patients. All patients with fixed defects had significant coronary artery disease.False positive studies were found to be significantly greater in patients with reversible defectsparticularly with mild to moderate defects. Conclusions: Patients with left bundle branch blockshowing moderate to severe reversible perfusion defects on dipyridamole thallium cardiac SPECThave high likelihood of coronary artery disease.Keywords: Left bundle branch block, Coronary artery disease, Thallium201 stress test, Myocardialperfusion imaging, Single-photon emission computed tomography (SPECT).
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