Initial experience with regadenoson stress positron emission tomography in patients with left bundle branch block: Low prevalence of septal defects and high accuracy for obstructive coronary artery disease
Assessing for coronary artery disease (CAD) in patients with left bundle branch block (LBBB) is difficult with noninvasive cardiac imaging. Few studies report the prevalence of LBBB associated septal-apical perfusion defects using regadenoson stress on Positron Electron Tomography (PET) imaging.
Methods and Results
We identified 101 consecutive patients with baseline LBBB, and without known CAD, who underwent rest-stress regadenoson PET. Investigators have the ability to prospectively identify studies, whose quality is limited by LBBB artifact. With the infusion of regadenoson, resting to peak stress heart rate rose from a median of 78 to 93 BPM. Despite this, LBBB perfusion artifacts were not identified in any studies. 10 individuals had both regadenoson SPECT and PET within 1 year. 3 of the 10 SPECT studies had LBBB artifacts, all of which were not seen on subsequent PET. 21 patients with PET had subsequent coronary angiography. Of these, 9 PETs were without significant inducible ischemia, and angiogram was without flow-limiting disease. 3 PETs identified inducible ischemia, but did not have flow-limiting disease on angiogram. 9 PETs identified inducible ischemia and had flow-limiting disease on angiogram.
In patients with LBBB undergoing regadenoson PET stress imaging, artifactual septal perfusion defects are rare.
KeywordsLeft bundle branch block positron emission tomography coronary artery disease regadenoson
Coronary artery disease
Institutional review board
Left anterior descending
Left bundle branch block
Myocardial perfusion imaging
Positron emission tomography
Right coronary artery
Single-photon emission computed tomography
Dane Meredith, Paul Cremer, Serge Harb, Bo Xu, Amgad Mentias, and Wael Jaber have no relationships relevant to the contents of this paper to disclose.
- 3.Hoefflinghaus T, Husmann L, Valenta I, Moonen C, Gaemperli O, Schepis T, et al. Role of Attenuation Correction to Discriminate Defects Caused by Left Bundle Branch Block Versus Coronary Stenosis in Single Photon Emission Computed Tomography Myocardial Perfusion Imaging. Clin Nucl Med 2008;33:748-51.CrossRefPubMedGoogle Scholar
- 7.Hayat SA, Dwivedi G, Jacobsen A, Lim TK, Kinsey C, Senior R. Effects of left bundle-branch block on cardiac structure, function, perfusion, and perfusion reserve: Implications for myocardial contrast echocardiography versus radionuclide perfusion imaging for the detection of coronary artery disease. Circulation 2008;117:1832-41.CrossRefPubMedGoogle Scholar
- 12.AlJaroudi W, Alraies MC, DiFilippo F, Brunken RC, Cerqueira MD, Jaber WA. Effect of stress testing on left ventricular mechanical synchrony by phase analysis of gated positron emission tomography in patients with normal myocardial perfusion. Eur J Nucl Med Mol Imaging 2012;39:665-72.CrossRefPubMedGoogle Scholar