Prognostic value of gated SPECT in patients with left bundle branch block

America, Y; Bax, Jeroen J.; Boersma, Eric; Stokkel, Marcel P. M.; Wall, Ernst E. van der

doi:10.1016/j.nuclcard.2006.10.018

Cited by 18 publications

(13 citation statements)

References 22 publications

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“…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%

“…The studies were carried out mostly in a relatively old patient population with a mean age of more than 65 years and mixed MPS results. One report describes the results of abnormal MPS [26] and another was restricted to normal MPS results in a relatively young patient population (59 years) [28]. Also, the endpoints differ between the reports.…”

Section: Prognostic Value Of Mps In Lbbbmentioning

confidence: 99%

“…High-risk MPS in patients with LBBB and RVA pacing Despite the fact that treatment was instigated based on the MPS results, the presence of an abnormal MPS in these patients carries the risk of a very high cardiac event rate [18,19,26,27]. These figures are significantly higher than those of patients with a low-risk MPS and the same conduction characteristics [18,19,22,27,28].…”

Section: The Prognostic Value Of Mpsmentioning

confidence: 99%

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

et al. 2011

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Prognostic Value Of Mps In Lbbbmentioning

confidence: 99%

Section: Prognostic Value Of Mps In Lbbbmentioning

confidence: 99%

Section: The Prognostic Value Of Mpsmentioning

confidence: 99%

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

et al. 2011

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“…5,[16][17][18][19][20] The literature is peppered with studies looking at low and intermediate Duke treadmill scores, patients with LBBB, left ventricular hypertrophy, and normal EKGs. 12,[21][22][23] There are papers looking at patients with suspected coronary disease, catheterization documented coronary disease, stable angina, and post infarction patients. 10,13,24,25 When it seems that the list is complete, when every conceivable subgroup has been identified and studied, Doukky et al 26 have managed to identify yet another group: MPI in an outpatient primary care setting.…”

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confidence: 99%

The prognosis for prognosis remains excellent

Hansen

2013

Journal of Nuclear Cardiology

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Do we really need another paper on prognosis? The topic has been explored exhaustively. We have seen studies identifying the ability of myocardial perfusion imaging (MPI) to stratify prognosis with planar imaging and SPECT, thallium, sestamibi, tetrofosmin, dual isotope, and rubidium. [1][2][3][4][5][6][7][8][9][10][11] We have heard about prognosis using treadmill exercise and pharmacologic stress using dipyridamole, adenosine, and dobutamine. 5,10,[12][13][14][15] We have read studies looking at men, women, metabolic syndrome, obesity, diabetics, and patients with endstage renal disease. 5,[16][17][18][19][20] The literature is peppered with studies looking at low and intermediate Duke treadmill scores, patients with LBBB, left ventricular hypertrophy, and normal EKGs. 12,[21][22][23] There are papers looking at patients with suspected coronary disease, catheterization documented coronary disease, stable angina, and post infarction patients. 10,13,24,25 When it seems that the list is complete, when every conceivable subgroup has been identified and studied, Doukky et al 26 have managed to identify yet another group: MPI in an outpatient primary care setting. As a group, this referral population would be expected to have less acuity and presumably a better prognosis, but as this group is more reflective of the general population it certainly merits careful scrutiny.They identified a consecutive series of 1,546 patients of whom greater than 1400 met entry criteria; a mean follow-up of 27 months was obtained in 99%. The majority of the scans were normal, only 12.5% were deemed abnormal due to perfusion defects, decreased function or both. Not surprisingly, the overall cardiac event rates were both hard events (mortality and myocardial infarction) and revascularization were low. Cox analysis once again showed that an abnormal MPI was a strong predictor of cardiac events while the overall event rates in patients with normal scans was quite low (0.54% death or MI) somewhat lower than the approximately 1% rate reported in cardiologist-based practices. The summed stress score, as in previous studies, showed a stepwise influence on prognosis.The study was performed using only a single blinded reader using semi-quantitative analysis with commercially available software. It should be noted that the authors used a SSS of C1 as abnormal, a deviation from most of the published literature. This is unlikely to effect the conclusions as the most important finding is the correlation between SSS and outcome and not where the line between normal and abnormal is drawn.This study raises important questions about appropriateness. This includes not just whether the indication for the test was appropriate but also the appropriate follow-up of abnormal tests and the appropriateness of the appropriate use criteria themselves. The authors report that nearly half the studies ordered were classified as inappropriate under the current AUC criteria. It is noted that AUC criteria were not as widely recognized during the time the study was con...

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Predictive variables for hard cardiac events and coronary revascularization in patients with normal left ventricular myocardial perfusion and systolic function

Romero-Farina

Candell‐Riera

Aguadé-Bruix

et al. 2013

Eur J Nucl Med Mol Imaging

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Prognostic value of gated SPECT in patients with left bundle branch block

Abstract: By use of quantitative gated SPECT imaging, LBBB patients with an end-diastolic volume of 160 mL or greater, end-systolic volume of 100 mL or greater, or LVEF lower than 35% are at increased risk for subsequent cardiac events.

Cited by 18 publications

References 22 publications

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

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

The prognosis for prognosis remains excellent

Predictive variables for hard cardiac events and coronary revascularization in patients with normal left ventricular myocardial perfusion and systolic function

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