Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Assessment of myocardial perfusion with thallium-201 scintigraphy in exercise-induced left bundle branch block: diagnostic value and clinical significance
Universitá degli Studi di Brescia, Cattedra di Cardiologia, Spedali Civili di Brescia. Divisione di Cardiologia Brescia, Italy
Servizio di Policardiografia Brescia, Italy
*Servizio di Medicina Nucleare Brescia, Italy
Received 7 November 1990; revised 29 October 1991; .
Correspondence: Giovanni La Canna, Divisione e Cattedra di Cardiologia, Univenrita degli Studi, Spedah Civili, 25100 Brescia, Italy.
Abstract
Myocardial perfusion scintigraphy with thallium-201 was performed in 33 subjects (mean age 45 years, range 28–61) with exercise-induced, rate-dependent left bundle branch block (LBBB) in order to assess both the value of Thallium-201 myocardial imaging for the diagnosis of coronary artery disease (CAD) and the pathogenesis (ischaemic or not) of the conduction defect. Of the 33 patients evaluated, 16 had chest pain suggestive of CAD and 17 were asymptomatic. None had a history of prior myocardial infarction or clinical and echocardiographic signs of heart disease. LBBB appeared at a heart rate ranging from 70 to 160b. min–1. Eighteen patients showed repolarization abnormalities (STsegment depression with deep inverted T waves) compatible with ischaemia, after QRS normalization.
Thallium-201 myocardial uptake was normal in 12 subjects; in the remaining 21, reversible Thallium-201 defects were demonstrated in the septum (18 patients), septum and apex (2), and septum and infero-apical wall (1). No patient had irreversible defects and all had normal coronary angiography\ with negative ergonovine tests for coronary artery spasm. The patients were followed up for a mean of 43 months (range 16–80). One patient died from sudden death, but no cardiac event occurred in the other patients.
In conclusion, exercise Thallium-201 myocardial scintigraphy showed a high prevalence (64%) of reversible perfusion defects in a group of patients with exercise-induced LBBB without any evidence of CAD at angiography or coronary spasm at ergonovine test. Moreover, follow-up showed a relatively low rate of major cardiac events.
Key Words: Exercise-induced left bundle branch block • Thallium-201 scintigraphy • coronary artery disease
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