Myocardial perfusion scintigraphy in left bundle branch block: A perspective on the issue from image analysis in a clinical context

Krishnan, Rajagopal; Lu, Jiyuan; Zhu, Yuying; Dae, Michael W.; Botvinick, Elias H.

doi:10.1016/0002-8703(93)90407-z

Cited by 19 publications

(7 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Like all non-invasive tests, SPECT is attended by a significant proportion of false negative and especially false positive results 20. These false positive SPECT images—for example, those associated with left bundle branch block21—may be the source of discrepancies with “false negative” (actually normal) myocardial contrast images (fig 6). Similarly, the overrepresentation of women—in whom stress imaging tests were probably performed to avoid misleading stress ECG results—may have contributed discrepancies because of false positive SPECT scans (related to breast attenuation) as well as false negative results related to the smaller left ventricular cavity 22.…”

Section: Discussionmentioning

confidence: 99%

Effect of power Doppler and digital subtraction techniques on the comparison of myocardial contrast echocardiography with SPECT

Haluska

Case²,

Short³

et al. 2001

Heart

View full text Add to dashboard Cite

Objective-To compare the accuracy and feasibility of harmonic power Doppler and digitally subtracted colour coded grey scale imaging for the assessment of perfusion defect severity by single photon emission computed tomography (SPECT) in an unselected group of patients. Design-Cohort study. Setting-Regional cardiothoracic unit. Patients-49 patients (mean (SD) age 61 (11) years; 27 women, 22 men) with known or suspected coronary artery disease were studied with simultaneous myocardial contrast echo (MCE) and SPECT after standard dipyridamole stress. Main outcome measures-Regional myocardial perfusion by SPECT, performed with 99m Tc tetrafosmin, scored qualitatively and also quantitated as per cent maximum activity. Results-Normal perfusion was identified by SPECT in 225 of 270 segments (83%). Contrast echo images were interpretable in 92% of patients. The proportion of normal MCE by grey scale, subtracted, and power Doppler techniques were respectively 76%, 74%, and 88% (p < 0.05) at > 80% of maximum counts, compared with 65%, 69%, and 61% at < 60% of maximum counts. For each technique, specificity was lowest in the lateral wall, although power Doppler was the least aVected. Grey scale and subtraction techniques were least accurate in the septal wall, but power Doppler showed particular problems in the apex. On a per patient analysis, the sensitivity was 67%, 75%, and 83% for detection of coronary artery disease using grey scale, colour coded, and power Doppler, respectively, with a significant diVerence between power Doppler and grey scale only (p < 0.05). Specificity was also the highest for power Doppler, at 55%, but not significantly diVerent from subtracted colour coded images. Conclusions-Myocardial contrast echo using harmonic power Doppler has greater accuracy than with grey scale imaging and digital subtraction. However, power Doppler appears to be less sensitive for mild perfusion defects. (Heart 2001;85:549-555)

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of power Doppler and digital subtraction techniques on the comparison of myocardial contrast echocardiography with SPECT

Haluska

Case²,

Short³

et al. 2001

Heart

View full text Add to dashboard Cite

show abstract

“…Of these 2 were not written in the English language, 19 did not assess the prognosis of patients with LBBB or RVA pacing with SPECT and 1 study could not be retrieved from the journal [24]. This left 11 articles for review that were carried out in patients with known or suspected CAD [19][20][21][22][25][26][27][28][29][30]. Two studies from the same investigators with possible double counting or overlap of patients, described the prognostic value of MPS in patients with RVA pacing [20,21].…”

Section: Resultsmentioning

confidence: 99%

“…Several reports studied the prognostic value of MPS in patients with LBBB [18,19,[26][27][28][29]31]. One report used the exercise characteristics for the prognostic value assessment and did not describe the results of the MPS.…”

Section: Prognostic Value Of Mps In Lbbbmentioning

confidence: 99%

Patients with left bundle branch block pattern and high cardiac risk myocardial SPECT: does the current management suffice?

et al. 2011

View full text Add to dashboard Cite

Introduction Myocardial perfusion SPECT (MPS) is frequently used for cardiovascular risk stratification. The significance of MPS in patients with abnormal electrical ventricular activation is often questionable. This review assesses the value of MPS for risk stratification of patients with intrinsic left bundle branch block or that due to right ventricular apical pacing. Methods We reviewed the literature by a search of the MEDLINE database (January 1980 to September 2010). The terms prognosis or prognostic value were combined with SPECT and LBBB or pacing or pacemakers. MPS was categorised as low and high risk according to the original definitions. Results We identified 11 studies suitable for review. A lowrisk MPS is associated with a low risk of cardiac events whereas high-risk MPS carries a 4.8-fold increased risk, 95% CI [3.2 -7.2] (p < 0.0001). Despite secondary prevention and an improved medical and interventional care, these figures have hardly changed over time. Conclusion and clinical implications A low-risk MPS permits a policy of watchful waiting whereas a high-risk MPS requires further analysis and treatment. The persistent high cardiac death and acute myocardial infarction rate after a high-risk MPS suggest that the current management of these patients does not suffice and needs reconsideration.

show abstract

“…However, due to the heterogenous effect of LBBB on myocardial structure, functions and perfusion in such patients, defects in MPS, anteroseptal and septal perfusion can also be observed in the absence of CAD [15,16]. Krishnan et al reported that the sensitivity of MPS in LBBB patients was 96% [for LAD: 84%, for CX: 50%, for RCA: 100%], and that the specificity of MPS in LBBB patients for LAD was 39%, for CX: 95%, and for RCA: 68% [17].…”

Section: The Non-invasive Procedures For the Investigation Of Cad In mentioning

confidence: 99%

Relationship of Fragmented Wide QRS Complexes with Coronary Atherosclerosis in Patients with Left Bundle Branch Block

Bayar¹,

Çağırcı²,

Çay³

et al. 2014

J Clin Exp Cardiolog

View full text Add to dashboard Cite

Objectıve: The non-invasive tests used in the diagnosis of Coronary Artery Disease (CAD) in patients with Left Bundle Branch Block (LBBB) are of limited use. The aim of this study is to investigate the relationship between the presence of Fragmented wide QRS [f-wQRS] and coronary atherosclerosis in patients with LBBB.Methods: This retrospective study included 75 patients who were admitted to our clinic with exertional chest pain and LBBB on electrocardiography and for whom it was decided to obtain coronary angiography as a result of clinical evaluation or positive scintigraphic results. The presence of f-wQRS was investigated in patients' electrocardiography prior to coronary angiography. Gensini score was calculated by examining the patients' coronary angiography records. Patient who had 75% and more stenosis in at least one coronary artery was defined as an obstructive CAD.

show abstract

Myocardial perfusion scintigraphy in left bundle branch block: A perspective on the issue from image analysis in a clinical context

Cited by 19 publications

References 28 publications

Effect of power Doppler and digital subtraction techniques on the comparison of myocardial contrast echocardiography with SPECT

Effect of power Doppler and digital subtraction techniques on the comparison of myocardial contrast echocardiography with SPECT

Patients with left bundle branch block pattern and high cardiac risk myocardial SPECT: does the current management suffice?

Relationship of Fragmented Wide QRS Complexes with Coronary Atherosclerosis in Patients with Left Bundle Branch Block

Contact Info

Product

Resources

About