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 |
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Authors: | N E Lebtahi J C Stauffer A Bischof Delaloye |
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Institution: | (1) Divisions of Nuclear Medicine and Cardiology, University Hospital, Lausanne, Switzerland;(2) Centre d'Imagerie, CIMED, rue de Locarno 9, 1700 Fribourg, Switzerland |
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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. |
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Keywords: | left bundle branch block dipyridamole thallium-201 single-photon emission computed tomography coronary artery disease |
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