Comparison of exercise and adenosine technetium-99m sestamibi myocardial scintigraphy for diagnosis of coronary artery disease in patients with left bundle branch block

Ebersole, Douglas G.; Heironimus, James D.; Toney, Morakinyo O.; Billingsley, J. V.

doi:10.1016/0002-9149(93)90453-j

Cited by 30 publications

(7 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In left bundle branch block patients, exercise-induced ST segment changes are non-specific for ischaemia [4,5] and myocardial perfusion studies, especially when exercise stress is used, and often suffer from false positive perfusion defects in the interventricular septum in the absence of left anterior descending coronary artery stenosis [6][7][8][9] . Pacing studies in dogs have indicated that regional myocardial blood flow and thallium-201 uptake during (mid) right ventricular pacing induced left bundle branch block was reduced in the septum compared to the lateral wall, whereas in right atrial pacing and normal ventricular depolarization myocardial blood flow and thallium-201 uptake was equal in the lateral and septal wall [6,26] .…”

Section: Detection Of Myocardial Ischaemiamentioning

confidence: 99%

“…Other proposed mechanisms include coronary spasm or small vessel coronary artery disease, septal fibrosis [28] , and technical factors, including wall motion artifact [29] . Because of the suspected major role of heart rate, an increase in the development of septal defects, vasodilator (dipyridamole, adenosine) perfusion imaging, which causes only a moderate increase in heart rate, is advocated as the stress test of choice in left bundle branch block patients to detect coronary artery disease [8,9] . Echocardiographically, myocardial ischaemia in the left anterior descending coronary artery territory can be assessed by stress-induced wall thickening abnormalities in the septum or anterior wall.…”

Section: Detection Of Myocardial Ischaemiamentioning

confidence: 99%

“…Unfortunately, most non-invasive stress tests have limited value for the detection of coronary artery disease in left bundle branch block patients. Exercise-induced ST segment changes are indeterminate for ischaemia [4,5] , and myocardial perfusion studies, especially exercise perfusion studies, often suffer from false positive perfusion defects in the interventricular septum in the absence of left anterior descending coronary artery stenosis [6][7][8][9] . Echocardiographically, left bundle branch block is characterized by asynchronous contraction of the ventricles [10] , resulting in the (M-mode) echocardiographic hallmark of left bundle branch block, the early systolic posteriorly directed septal notch, first described by McDonald in 1973 [11] .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Usefulness and limitations of dobutamine–atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study

Geleijnse

Vigna

Kasprzak

et al. 2000

European Heart Journal

View full text Add to dashboard Cite

Background Patients with left bundle branch block exhibit abnormal septal motion which may limit the interpretation of stress echocardiograms. This study sought to assess the diagnostic value of dobutamine-atropine stress echocardiography in left bundle branch block patients. Methods and ResultsSixty-four left bundle branch block patients (mean age 59 years, 24 men) with suspected coronary artery disease underwent dobutamine-atropine stress echocardiography and coronary arteriography. Myocardial ischaemia was defined as new or worsening wall thickening abnormalities. Coronary artery disease was quantitatively defined as a diameter stenosis d50% in a major epicardial artery. Rest septal motion was normal (apart from the early systolic septal notch) in 34 patients (53%) and abnormal in 30 patients (47%). Rest septal thickening was normal in 32 patients (50%) and abnormal in 32 patients (50%). All seven patients with a QRS duration d160 ms and an abnormal QRS axis had abnormal rest septal motion and thickening. Inter-observer agreement for ischaemia was 88%. In all but one patient disagreement was in the septum. For the anterior and posterior circulation, respectively, sensitivity was 60% (9/ 15) and 67% (8/12), specificity was 94% (46/49) and 98% (51/52), and accuracy was 86% (55/64) and 92% (59/64). Sensitivity for the anterior circulation tended to be better in patients with normal rest septal thickening (83% vs 44%).Conclusions Dobutamine-atropine stress echocardiography has excellent diagnostic specificity in left bundle branch block patients with suspected coronary artery disease. In patients with abnormal rest septal thickening, however, dobutamine-atropine stress echocardiography may lack good sensitivity for detection of coronary artery disease in the anterior circulation. Left bundle branch block patients who potentially most benefit from dobutamine-atropine stress echocardiography may initially be selected by their resting electrocardiogram.

show abstract

Section: Detection Of Myocardial Ischaemiamentioning

confidence: 99%

Section: Detection Of Myocardial Ischaemiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Usefulness and limitations of dobutamine–atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study

Geleijnse

Vigna

Kasprzak

et al. 2000

European Heart Journal

View full text Add to dashboard Cite

show abstract

“…38 (45) 19 (23) 7 (8) 1 (1) 4 (5) 27 (32) 31 (37) Group 2 (Low Risk; n=161), n (%) 31 (19) 6 (4) 3 (2) 0 12 (7) 9 (6) 21 (13) Early revascularization (before 3 months) 10 15 (18) 4 (2) CABG indicates coronary artery bypass graft; PICA, percutaneous transluminal coronary angioplasty.…”

Section: Secondary Analysesmentioning

confidence: 99%

“…Several studies have shown that perfusion imaging with vasodilators (dipyridamole and adenosine) is superior to exercise for detection of coronary artery disease in patients with left bundle-branch block. 13 " 18 Pharmacological perfusion imaging has been shown to be useful for prognostic purposes in patients without left bundlebranch block. 19 ' 20 However, the prognostic value of vasodilator stress perfusion imaging with either thallium-201 or technetium99m sestamibi and either adenosine or dipyridamole has not been studied in patients with left bundle-branch block.…”

mentioning

confidence: 99%

Prognostic Value of Vasodilator Myocardial Perfusion Imaging in Patients With Left Bundle-Branch Block

Wagdy¹,

Hodge²,

Christian³

et al. 1998

Circulation

View full text Add to dashboard Cite

Background-The prognostic value of tomographic myocardial perfusion imaging with dipyridamole or adenosine in patients with left bundle-branch block has not been established. Methods and Results-The study group consisted of 245 patients with left bundle-branch block who underwent tomographic (single photon emission tomography) myocardial perfusion imaging with thallium-201 (n=173) or technetium-99m sestamibi (n=72) and either dipyridamole (n=153) or adenosine (n=92) stress. Patients were prospectively classified into two groups. Patients were classified as "high risk" if they had (1) a large severe fixed defect (n=28), (2) a large reversible defect (n=36), or (3) cardiac enlargement and either increased pulmonary uptake (thallium) or a decreased resting ejection fraction (sestamibi) (n=20). The remaining 161 patients (66% of the study group) were at "low risk." Follow-up was 99% complete at 3 ±1.4 years. Three-year overall survival was 57% in the high-risk group compared with 87% in the low-risk group (P<.0001). Survival free of cardiac death/nonfatal myocardial infarction/cardiac transplantation was 55% in the high-risk group and 93% in the low-risk group (P<.0001). The presence of a high-risk scan had significant incremental prognostic value after adjustment for age, sex, diabetes, and previous myocardial infarction (P<.0001). Patients with a low-risk scan had an overall survival that was not significantly different from that of a US age-matched population (P=.86). Conclusions-Tomographic myocardial perfusion imaging with adenosine or dipyridamole stress provides important prognostic information in patients with left bundle-branch block, which is incremental to clinical assessment.

show abstract

Noninvasive Imaging of Myocardial Ischemia

Anagnostopoulos¹,

Nihoyannopoulos²,

Bax³

et al. 2006

View full text Add to dashboard Cite

Comparison of exercise and adenosine technetium-99m sestamibi myocardial scintigraphy for diagnosis of coronary artery disease in patients with left bundle branch block

Cited by 30 publications

References 8 publications

Usefulness and limitations of dobutamine–atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study

Usefulness and limitations of dobutamine–atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study

Prognostic Value of Vasodilator Myocardial Perfusion Imaging in Patients With Left Bundle-Branch Block

Noninvasive Imaging of Myocardial Ischemia

Contact Info

Product

Resources

About