Abstract
Patients with left bundle branch block (LBBB) often show abnormal images on exercise thallium (Tl)-201 scintigraphy without evidence of significant coronary stenosis. We investigated the mechanism for this phenomenon. Six patients with LBBB and without significant coronary stenosis underwent Tl-201 SPECT, ECG-gated SPECT imaging with Tc-99m-methoxyisobutyl-isonitrile (MIBI), and atrial pacing stress test. The % count amplitude in Tc-99m-MIBI images was calculated as (maximal counts) — (minimal counts)/(minimal counts) X 100. Though all patients had a low count in the septal and inferior wall in Tl-201 SPECT images, there was no ischemic production of lactate during an atrial pacing stress test. Nevertheless, gated SPECT images showed attenuated septal activity during systole. In patients with LBBB, the ratios of % count amplitude at the septum to that at the lateral wall at rest (0.47 ± 0.05, mean ± SE) were significantly less than the controls (n = 5, 0.83 ± 0.12, p = 0.014). In conclusion, these results suggest that abnormal Tl-201 SPECT images of the septum in patients with LBBB are partially caused by impaired septal wall thickening during systole. Such an abnormal wall motion may reduce blood flow demands to the septum, resulting in reduction of coronary blood flow with little ischemia.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Takeda T, Toyama H, Ishikawa N, Satoh M, Masuoka T, Ajisaka R, et al. Quantitative phase analysis of myocardial wall thickening by technetium-99m 2-methoxy-isobutylisonitrile SPECT.Ann Nucl Med 6: 69–78, 1992.
Yamamoto K, Asada S, Masuyama T, Nanto S, Matsumura Y, Naito J, et al. Myocardial hibernation in the infarcted region cannot be assessed from the presence of stressinduced ischemia: Usefulness of delayed image of exercise thallium-201 scintigraphy.Am Heart J 125: 33–40, 1993.
Dillon JC, Chang S, Feigenbaum H. Echocardiographic manifestations of left bundle branch block pattern.Circulation 49: 876–880, 1974.
Sugihara H, Tamaki N, Nozawa M, Ohmura T, Inamoto Y, Taniguchi Y, et al. Septal perfusion and wall thickening in patients with left bundle branch block assessed by technetium-99m-sestamibi gated tomography.J Nucl Med 38: 545–547, 1997.
Fukuchi K, Uehara T, Morozumi T, Tsujimura E, Hasegawa S, Yutani K, et al. Quantification of systolic count increase in technetium-99m MIBI ECG-gated myocardial SPECT.J Nucl Med 38: 1067–1073, 1997.
Cooke CD, Garcia EV, Cullom SJ, Faber TL, Pettigrew RI. Determining the accuracy of calculating systolic wall thickening using a fast Fourier transform approximation: a simulation study based on canine and patient data.J Nucl Med 35: 1185–1192, 1994.
Hirzel HO, Serai M, Nuesch K, Buettner C, Pfeiffer A, Hess OM, et al. TalIium-201 scintigraphy in complete left bundle branch block.Am J Cardiol 53: 764–769, 1984.
Ono S, Nohara R, Kambara H, Okuda K, Kawai C. Regional myocardial perfusion and glucose metabolism in experimental left bundle branch block.Circulation 85: 1125–1131, 1992.
Altehoefer C, vom Dahl J, Buell U. Septal glucose metabolism in patients with coronary artery disease and left bundlebranch block.Coronary Artery Disease 4: 569–572, 1993.
O’Keefe JH, Bateman TM, Sivestri R, Barnhart C. Safety and diagnostic accuracy of adenosine thallium-201 scintigraphy in patients unable to exercise and those with left bundle branch block.Am Heart J 124: 614–621, 1992.
O’Keefe JH, Bateman TM, Barnhart CS. Adenosine thallium-201 is superior to exercise thallium-201 for detecting coronary artery disease in patients with left bundle branch block.J Am Coll Cardiol 21: 1332–1338, 1993.
Jukema JW, Wall EE, Vis-Melsen MJE, Kruyswijk HH, Bruschke AVG. Dipyridamole thallium-201 scintigraphy for improved detection of left anterior descending coronary artery stenosis in patients with left bundle branch block.Eur Heart J 14: 53–56, 1993.
Tighe DA, Hutchinson HG, Park CH, Chung EK, Fischman DL, Raichlen JS. False-positive reversible perfusion defect during dobutamine-thallium imaging in left bundle branch block.J Nucl Med 35: 1989–1991, 1994.
Knapp WH, Bentrup A, Schmidt U, Ohlmeier H. Myocardial scintigraphy with thallium-201 and technetium-99m-hexakis-methoxyisobutylisonitrile in left bundle branch block: a study in patients with and without coronary artery disease.Eur J Nucl Med 20: 219–224, 1993.
Tawarahara K, Kurata C, Taguchi Y, Kobayashi A, Yamazaki N. Exercise testing and thallium-201 emission computed tomography in patients with intraventricular conduction disturbances.Am J Cardiol 69: 97–102, 1992.
Burns RJ, Galligan L, Wright LM, Lawand S, Burke RJ, Gladstone PJ. Improved specificity of myocardial thallium-201 single-photon emission computed tomography in patients with left bundle branch block by dipyridamole.Am J Cardiol 68: 504–508, 1991.
Jazmati B, Sadaniantz A, Emaus SP, Heller GV. Exercise thallium-201 imaging in complete left bundle branch block and the prevalence of septal perfusion defects.Am J Cardiol 67: 46–49, 1991.
Canna GL, Giubbini R, Metra M, Arosio G, Curnis A, Cicogna R, et al. Assessment of myocardial perfusion with thallium-201 scintigraphy in exercise-induced left bundle branch block: diagnostic value and clinical significance.Eur Heart J 13: 942–946, 1992.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hasegawa, S., Sakata, Y., Ishikura, F. et al. Mechanism for abnormal thallium-201 myocardial scintigraphy in patients with left bundle branch block in the absence of angiographic coronary artery disease. Ann Nucl Med 13, 253–259 (1999). https://doi.org/10.1007/BF03164901
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03164901