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The Quarterly Journal of Nuclear Medicine 2001 March;45(1):108-14


language: English

Perfusion and functional abnormalities outside the septal region in patients with left bundle branch block assessed with gated SPECT

Bavelaar-Croon C. D. L. °, Wahba F. F. M. F. °*, Van Hecke M. V. °*, Atsma D. E. *, Stokkel M. P. M. °, Pauwels E. K. J. °, Van der Wall E. E. *

From the Department of Radiology °Division of Nuclear Medicine *Department of Cardiology Leiden University Medical Center, Leiden, The Netherlands


Background. The pres­ence of a ­left bun­dle ­branch ­block (­LBBB) pat­tern on the elec­tro­car­di­o­gram may fre­quent­ly ­lead to per­fu­sion ­defects in the sep­tum not nec­es­sar­i­ly due to ischem­ic ­heart dis­ease, but prob­ably due to abnor­mal sep­tal ­wall ­motion. The intro­duc­tion of gat­ed sin­gle pho­ton emis­sion com­put­ed tomog­ra­phy (­SPECT) ­allows the eval­u­a­tion of myo­car­dial per­fu­sion and func­tion in one ­study. Accordingly, we ana­lysed per­fu­sion and func­tion and the rela­tion ­between per­fu­sion and region­al func­tion in the sep­tal ­region in ­patients ­with a ­LBBB with­out evi­dence of a pre­vi­ous­ly sus­tained myo­car­dial infarc­tion.
Methods. We select­ed 37 ­patients ­with a ­LBBB with­out a his­to­ry of a pre­vi­ous myo­car­dial infarc­tion, ­which was con­firmed by ech­o­car­di­og­ra­phy and/or cor­o­nary angio­gra­phy. All ­patients under­went tech­ne­tium-99m tet­ro­fos­min gat­ed ­SPECT myo­car­dial imag­ing. Twelve con­trol ­patients ­with a low like­li­hood of cor­o­nary ­artery dis­ease and a nor­mal tech­ne­tium-99m tet­ro­fos­min gat­ed ­SPECT myo­car­dial per­fu­sion scin­ti­gram ­were select­ed as a ref­er­ence pop­u­la­tion. The ­left ven­tri­cle (LV) was divid­ed ­into 18 seg­ments, ­which ­were ­scored for per­fu­sion and func­tion (­wall ­motion and ­wall thick­en­ing) on a 4-­point ­scale.
Results. The aver­age LV end-dia­stol­ic vol­ume was high­er and the aver­age LV ejec­tion frac­tion was low­er in ­patients ­with ­LBBB as com­pared to con­trols (142±90 vs. 81±18 ml, and 48±19 vs 62±7%, p=0.03 and p=0.02, respec­tive­ly). Not ­only in the sep­tum, but ­also in the oth­er seg­ments, ­reduced myo­car­dial per­fu­sion and abnor­mal ­wall ­motion/­wall thick­en­ing was ­observed in the ­patients ­with ­LBBB (p<0.0001 vs con­trols). Patients ­with ­LBBB ­showed no cor­re­la­tion ­between per­fu­sion and func­tion in the sep­tum, and ­between per­fu­sion in sep­tum and glo­bal LV func­tion (r=0.21, p=0.2; r=0.10, p=0.6, respec­tive­ly). Conversely, a ­good cor­re­la­tion was ­found ­between per­fu­sion and func­tion, ­either region­al or glo­bal, in the ­remote seg­ments (­both r=0.79, p<0.0001).
Conclusions. We con­clude ­that ­patients ­with ­LBBB with­out a pre­vi­ous myo­car­dial infarc­tion ­show car­di­om­yo­path­ic chang­es ­with per­fu­sion and ­wall ­motion abnor­mal­ities, involv­ing the ­entire ­left ven­tri­cle. The sever­ity of dimin­ished sep­tal per­fu­sion is not direct­ly asso­ciat­ed ­with the sever­ity of sep­tal ­wall ­motion abnor­mal­ities or glo­bal LV func­tion. However, in the myo­car­dial seg­ments ­remote ­from the sep­tum, ­reduced per­fu­sion is close­ly asso­ciat­ed ­with func­tion­al abnor­mal­ities.

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