Left ventricular performance during exercise in patients with left bundle branch block: Evaluation by gated radionuclide ventriculography

Rowe, Dennis W.; Puey, E.G. De; Sonnemaker, Robert E.; Hall, Robert J.; Burdine, John A.

doi:10.1016/0002-8703(83)90280-6

Cited by 17 publications

(8 citation statements)

References 11 publications

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“…In group I patients a reduced LVEF and a septal hypokinesis or akinesis were observed at rest, according to previous studies [6,13].…”

Section: Discussionmentioning

confidence: 86%

“…It has been demonstrated that intermit tent LBBB in patients with no apparent car diovascular disease may determine during an exercise test reduced LVEF, asynchro nous LV contraction, and hypokinesis [2] indistinguishable from those observed in pa tients with chronic LBBB [2,6], However, in the normal heart, intermit tent LBBB seems to have no significant ef fect on LV performance at rest [2,14], unlike chronic LBBB [6,13].…”

Section: Discussionmentioning

confidence: 99%

“…How ever, it is worthy o f note that both group I and group II patients exhibited similar 20IT1 exercise scans; in all 9 patients distinct defects were found only in the anteroseptal wall which filled in after 4 h of redistribu tion. In patients with chronic or intermittent LBBB and normal coronary arteriograms 20IT1 reversible defects frequently occur in the anteroseptal wall only; the interpretation of these findings remain specula tive, but they cannot be considered by themselves indicative of CAD, especially in asymptomatic pa tients [1,[4][5][6]8],…”

Section: Patient Populationmentioning

confidence: 99%

“…These findings seem to confirm that LBBB, chronic or intermittent, is able to deteriorate LV performance at rest, even in patients with an otherwise normal heart. Previous studies [2,6] have demonstrated that in the presence of left bundle branch block (LBBB) global and regional left ven tricular (LV) dysfunctions generally occur during an exercise test, both in diseased and apparently normal heart. In these instances, however, the effort by itself may play a role in deterioration of the LV function inducing a myocardial ischemia [4] or unmasking a latent myocardial impairment [6], To further evaluate the independent ef fects of LBBB on LV performance, we per formed radionuclide angiocardiography (RNA) at rest in a group of patients with chronic or intermittent LBBB and an other wise normal heart.…”

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confidence: 99%

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Effects of Left Bundle Branch Block on Left Ventricular Function in Apparently Normal Subjects

et al. 1988

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To determine the independent effects of left bundle branch block (LBBB) on global and regional left ventricular (LV) function we performed equilibrium radionuclide angiocardiography at rest in 3 patients with chronic LBBB (group I, mean age 53.6 years and in 6 patients with intermittent LBBB (group II, mean age 41.5 years). All patients were judged to have an apparently normal heart. In 2 of 3 patients of group I a LV ejection fraction lower than 50% was observed, and in all 3 patients septal motion abnormalities were present. In all patients of group II the global LV ejection fraction was normal during normal conduction and decreased during LBBB; the inferoapical regional ejection fraction decreased in 5 of 6 cases and the posterolateral regional ejection fraction in 3 of 6 cases. Moreover, septal hypokinesis was observed both during normal and abnormal conduction in all group II patients. These findings seem to confirm that LBBB, chronic or intermittent, is able to deteriorate LV performance at rest, even in patients with an otherwise normal heart.

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“…In group I patients a reduced LVEF and a septal hypokinesis or akinesis were observed at rest, according to previous studies [6,13].…”

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Patient Populationmentioning

confidence: 99%

mentioning

confidence: 99%

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Effects of Left Bundle Branch Block on Left Ventricular Function in Apparently Normal Subjects

et al. 1988

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“…Interpretation of routine exercise treadmill testing with electrocardiographic monitoring may be limited in these patients by the presence of baseline electrocardiographic abnormalities associated with left ventricular hypertrophy, medication effects, left bundle branch block, or advanced age. 1 …”

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confidence: 99%

Thallium-201 stress imaging in hypertensive patients.

Schulman¹,

Francis²,

Black³

et al. 1987

Hypertension

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SUMMARY To assess the potential effect of hypertension on the results of thallium-201 stress imaging in patients with chest pain, 272 thallium-201 stress tests performed in 133 hypertensive patients and 139 normotensive patients over a 1-year period were reviewed. Normotensive and hypertensive patients were similar in age, gender distribution, prevalence of cardiac risk factors (tobacco smoking, hyperlipidemia, and diabetes mellitus), medications, and clinical symptoms of coronary disease. Electrocardiographic criteria for left ventricular hypertrophy were present in 16 hypertensive patients. Stepwise probability analysis was used to determine the likelihood of coronary artery disease for each patient. In patients with mid to high likelihood of coronary disease (>25% probability), abnormal thallium-201 stress images were present in 54 of 60 (90%) hypertensive patients compared with 51 of 64 (80%) normotensive patients. However, in 73 patients with a low likelihood of coronary disease ( s 25% probability), abnormal thallium-201 stress images were present in 21 patients ( SINCE hypertension is a major risk factor for the development of coronary artery disease, the reliability of stress testing for the evaluation of chest pain in patients with abnormal blood pressure elevation is an important clinical concern. Interpretation of routine exercise treadmill testing with electrocardiographic monitoring may be limited in these patients by the presence of baseline electrocardiographic abnormalities associated with left ventricular hypertrophy, medication effects, left bundle branch block, or advanced age. "3 Furthermore, in a study of hypertensive patients with chest pain, exercise radionuclide angiography was found to be an inadequate screening test for coronary artery disease because of the frequent occurrence of false-positive responses. 4 Since stressinduced thallium-201 myocardial defects are a more specific indicator of abnormal regional myocardial perfusion than are electrocardiographic or hemodynamic criteria, exercise testing with thallium-201 imaging may be a more useful test in hypertensive patients. Therefore, thallium-201 stress imaging may be more suited than other diagnostic techniques for the identification of ischemia.5 There is little information concerning the effects of hypertension and possibly associated left ventricular hypertrophy on thallium-201 imaging in patients evaluated for chest pain. To assess the effects of hypertension on the results of thallium-201 stress testing, we reviewed our experience over a 1-year period with normotensive and hypertensive patients who were referred for exercise testing with thallium-201 imaging. The patients were categorized according to their likelihood of having coronary artery disease. We hypothesized that hypertensive patients would have a higher incidence of abnormal thallium-201 imaging than would their normotensive counterparts.

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Intermittent Left Bundle Branch Block and Associated T-Wave Abnormalities

Michelotti¹

1985

Arch Intern Med

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Left ventricular performance during exercise in patients with left bundle branch block: Evaluation by gated radionuclide ventriculography

Cited by 17 publications

References 11 publications

Effects of Left Bundle Branch Block on Left Ventricular Function in Apparently Normal Subjects

Effects of Left Bundle Branch Block on Left Ventricular Function in Apparently Normal Subjects

Thallium-201 stress imaging in hypertensive patients.

Intermittent Left Bundle Branch Block and Associated T-Wave Abnormalities

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