Is the treadmill exercise test useful for evaluating coronary artery disease in patients with complete left bundle branch block?

Orzan, F; Garcia, Efrain; Mathur, Virendra S.; Hall, Robert J.

doi:10.1016/0002-9149(78)90981-5

Cited by 62 publications

(29 citation statements)

References 13 publications

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“…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%

“…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%

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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

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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.

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Section: Detection Of Myocardial Ischaemiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

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“…Furthermore, electrocardiographic monitoring for the detection of ischemia may be impossible if certain conduction disturbances or paced rhythms are present.5 6 Nevertheless, the ECG remains the monitor most commonly used to diagnose intraoperative myocardial ischemia.…”

mentioning

confidence: 99%

Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography.

Smith¹,

Cahalan²,

Benefiel³

et al. 1985

Circulation

449

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Because acute segmental wall motion abnormalities (SWMAs) of the left ventricle are highly sensitive and specific indicators of myocardial ischemia, this study compared the incidence and significance of ischemia, as detected by two-dimensional transesophageal echocardiography and surface electrocardiography, during anesthesia and surgery in patients at high risk of myocardial ischemia. During surgery, 24 of the 50 patients studied had new SWMAs, whereas only six had ST segment changes. All patients with ST segment changes also had new SWMAs: in three instances, SWMAs occurred before the ST segment change, and in three instances, they occurred simultaneously. All three patients who had intraoperative myocardial infarctions also had persistent intraoperative SWMAs, whereas only one patient had ST segment changes. Ten healthy patients requiring noncardiovascular surgery were monitored similarly; none of these had SWMAs, ST segment changes, or myocardial infarction. This study demonstrates the superiority of two-dimensional transesophageal echocardiography over electrocardiography for the intraoperative detection of myocardial ischemia. Furthermore, when new SWMAs persist to the conclusion of surgery, myocardial infarction is likely to have occurred.

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“…Todėl išeminės širdies ligos nustatymas pacientams, turintiems šį laidumo sutrikimą, padeda pasirinkti gydymo taktiką. Tačiau KHPKB, sąlygojanti nesinchronišką skilvelių kontrakciją ir relaksaciją, sunkina išeminės širdies ligos diagnostiką įprastiniais neinvaziniais tyrimo metodais (krūvio EKG, echokardioskopija) (4,5). Krūvio radionuklidinės kompiuterinės tomografijos metu anteroseptalinėje srityje dažnai registruojami grįžtami perfuzijos defektai, kurių priežastis gali būti ne arterijos spindžio susiaurėjimas, o nesinchroniškos skilvelių veiklos sąlygotas miokardo mikrocirkuliacijos pablogėjimas (6,7).…”

Section: įVadasunclassified

“…DKT aparatai sparčiai tobulinami, tačiau tiek 16 detektorių, tiek naujesnės kartos 64 detektorių aparatais atliktuose tyrimuose išlieka artefaktų, sąlygotų vainikinių arterijų judesio ar stambių kalcifikatų tikiMedicina (Kaunas) 2009; 45 (4) …”

Section: įVadasunclassified

Subintimal angioplasty: an alternative to open surgery of the lower limb chronic artery occlusion

Aleksynas

Kaupas²,

Antuševas³

2009

Medicina

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77,8 proc., specifiškumas -92,3 proc., teigiama prognostinė vertė -70 proc., neigiama prognostinė vertė -94,7 proc. Palyginus kiekvieno paciento tyrimų duomenis, kompiuterinės tomografijos jautrumas buvo 81,8 proc., specifiškumas -84,6 proc., teigiama prognostinė vertė -81,8 proc., neigiama prognostinė vertė -84,6 proc. Išvados. Vainikinių arterijų angiografija, atlikta daugiapjūviu kompiuteriniu tomografu, pasižymi aukštu diagnostiniu tikslumu nustatant hemodinamiškai reikšmingas stenozes esant kairiosios Hiso pluošto kojytės blokadai.Adresas susirašinėti: A. Jankauskas, KMU Radiologijos klinika, Eivenių 2, 50009 Kaunas El. paštas: jankauskas.antanas@gmail.com ĮvadasKairiosios Hiso pluošto kojytės blokada (KHPKB) yra susijusi su didesne širdies ir kraujagyslių ligų komplikacijų rizika, ypač pacientams, sergantiems išemine širdies liga (1-3). Todėl išeminės širdies ligos nustatymas pacientams, turintiems šį laidumo sutrikimą, padeda pasirinkti gydymo taktiką. Tačiau KHPKB, sąlygojanti nesinchronišką skilvelių kontrakciją ir relaksaciją, sunkina išeminės širdies ligos diagnostiką įprastiniais neinvaziniais tyrimo metodais (krūvio EKG, echokardioskopija) (4, 5). Krūvio radionuklidinės kompiuterinės tomografijos metu anteroseptalinėje srityje dažnai registruojami grįžtami perfuzijos defektai, kurių priežastis gali būti ne arterijos spindžio susiaurėjimas, o nesinchroniškos skilvelių veiklos sąlygotas miokardo mikrocirkuliacijos pablogėjimas (6, 7). Diagnozei patikslinti šiems pacientams dažnai tenka atlikti intervencinę vainikinių arterijų angiografiją. Todėl daugiapjūvės kompiuterinės tomografijos (DKT) tyrimas pastaruoju metu pradėtas taikyti ateroskleroziniams pokyčiams vainikinėse arterijose vizualizuoti, gali būti vertingas neinvazyvus diagnostikos metodas esant šio tipo laidumo sutrikimui (8).DKT aparatai sparčiai tobulinami, tačiau tiek 16 detektorių, tiek naujesnės kartos 64 detektorių aparatais atliktuose tyrimuose išlieka artefaktų, sąlygotų vainikinių arterijų judesio ar stambių kalcifikatų tikiMedicina (Kaunas) 2009; 45(4) KLINIKINIAI TYRIMAI

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Is the treadmill exercise test useful for evaluating coronary artery disease in patients with complete left bundle branch block?

Cited by 62 publications

References 13 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

Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography.

Subintimal angioplasty: an alternative to open surgery of the lower limb chronic artery occlusion

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